Publications by authors named "Hiroshi Murayama"

129 Publications

Objectively measured intensity-specific physical activity and hippocampal volume among community-dwelling older adults.

J Epidemiol 2021 Mar 13. Epub 2021 Mar 13.

Department of Active Aging (donated by Tokamachi city, Niigata Japan), Niigata University Graduate School of Medical and Dental Sciences.

Background: The hippocampus is a brain structure important for memory and cognitive function. Physical activity may help prevent hippocampal atrophy. However, few studies have measured sedentary behavior (SB) and intensity-specific physical activity using an accelerometer. This study aimed to examine the cross-sectional associations of objectively-determined SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) measured by an accelerometer with hippocampal volume among community-dwelling older adults using compositional data analysis (CoDa) approach.

Methods: This cross-sectional study was part of the Neuron to Environmental Impact across Generations (NEIGE) study. A randomly recruited sample of 485 Japanese older adults (47% male; aged 65-84 years) wore tri-axial accelerometers (Omron Healthcare) for seven consecutive days in 2017. Hippocampal volume was measured with magnetic resonance imaging and the left and right hippocampal volumes were automatically segmented using FreeSurfer software. Associations of sedentary and physically active behaviors with hippocampal volume were examined with compositional linear regression analysis based on isometric log-ratio transformations of time use adjusted for potential confounding factors.

Results: The relative proportion of time spent in MVPA, compared to the other two activities, was significantly positively associated with right hippocampal volume (β: 57.1, p-value = 0.027).However, no association existed between higher proportions of MVPA and left hippocampal volume, or between proportions of SB or LPA with either left or right hippocampal volumes.

Conclusions: The proportion of time spent in MVPA, relative to the other two activities, was significantly positively associated with right hippocampal volume. MVPA may be beneficial for maintaining hippocampal volume.
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http://dx.doi.org/10.2188/jea.JE20200534DOI Listing
March 2021

Short-, medium-, and long-term weight changes and all-cause mortality in old age: Findings from the National Survey of the Japanese Elderly.

J Gerontol A Biol Sci Med Sci 2021 Feb 24. Epub 2021 Feb 24.

Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan.

Background: Recent studies, predominantly in Western populations, suggest that both weight loss and weight gain are associated with an increased mortality risk in old age. However, evidence of this association in older Asian populations remains sparse. This study aimed to examine the association between weight change and all-cause mortality in a nationally representative sample of community-dwelling older Japanese people.

Methods: Data were obtained from the National Survey of the Japanese Elderly, which included 4,869 adults aged ≥60 years. Participants were followed for up to 30 years. We considered three indicators of weight change according to the follow-up interval: short-term (3 years), medium-term (6-7 years), and long-term (12-13 years). Weight change was classified as loss ≥5%, loss 2.5-4.9%, stable (±2.4%), gain 2.5-4.9%, and gain ≥5%. Cox proportional hazards models were used to calculate the relative mortality risk of each weight change category.

Results: Weight loss ≥5% for all intervals was associated with higher mortality than stable weight and the effects were largely similar across all three intervals (hazard ratio [95% confidence interval]: 1.36 [1.22-1.51] for short-term, 1.36 [1.22-1.51] for medium-term, and 1.31 [1.11-1.54] for long-term). A similar pattern of results was observed among the young-old and old-old, and among men and women. The effect of weight loss on higher mortality was greater among those with a lower body mass index at baseline.

Conclusions: These findings could inform clinical and public health approaches to body-weight management aimed at improving the health and survival of older adults, particularly in Asian populations.
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http://dx.doi.org/10.1093/gerona/glab052DOI Listing
February 2021

Decomposition of gender differences in cognitive functioning: National Survey of the Japanese elderly.

BMC Geriatr 2021 Jan 10;21(1):38. Epub 2021 Jan 10.

Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan.

Background: It is well known that females generally live longer than males, but women tend to suffer from more illnesses and limitations than men do, also for dementia. However, limited empirical evidence is available why this 'male-female health-survival paradox' is observed. This study aimed to investigate factors which account for gender differences in health, particularly cognitive functioning and decline among older adults.

Methods: Data were retrieved from the National Survey of the Japanese Elderly, which is a longitudinal survey of a nationwide representative sample of Japanese adults aged 60 or over. Gender differences in cognitive functioning and decline in three-year follow-ups were decomposed using Blinder-Oaxaca decomposition analysis, regarding demographic, socioeconomic, and health-related factors into the 'explained' component, by differences in individual attributes listed above, and the 'unexplained' component.

Results: Empirical analyses showed that women's lower cognitive functioning was partly explained by the endowment effect. Moreover, a shorter duration of formal education and a larger proportion with their longest occupation being domestic worker accounted for steeper cognitive decline and more prevalent mild cognitive impairment in women than in men.

Conclusion: This empirical study suggested that gender differences in cognitive functioning and decline account for different individual attributes of social determinants among men and women. Particularly, men seem to be more engaged in activities which accumulate intellectual experiences through education and occupation, as suggested by the cognitive reserve hypothesis.
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http://dx.doi.org/10.1186/s12877-020-01990-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798327PMC
January 2021

[Characteristics of older people willing to offer lifestyle support to other community members living in rural areas with heavy snowfall].

Nihon Koshu Eisei Zasshi 2020 ;67(12):860-870

Division of Health Sciences, Tohoku University Graduate School of Medicine.

Objective The increasing aging population has increased the number of older people who need lifestyle support because of their declining mental and physical health. In recent years, it has become necessary to increase the number of residents who can provide lifestyle support. It is highly expected that older people, as local residents, will be keen to offer lifestyle support. This study identified the characteristics of older people willing to offer lifestyle support to other members of the community living in rural areas with heavy snowfall.Methods We surveyed 801 people, aged 65 years and above, who lived in Yoshijima, Kawanishi town, Yamagata Prefecture, and were not certified in nursing care levels 1-5. A questionnaire was distributed and collected by the president of the neighborhood association and the head of the neighboring group. Data were collected from June to July 2018. The survey included items on basic attributes, health status, social relations with neighbors, and willingness to offer lifestyle support (eight types). A logistic regression analysis was conducted for each support type, with basic attributes, health status, and social relations with neighbors as independent variables and willingness to offer lifestyle support as the dependent variable.Results We analyzed the data of 586 participants (73.2% valid responses) and found that women were interested in "being a talking partner/consultant in cases of trouble," "helping with meal preparation/cleaning and laundry," and "inviting their neighbors to gatherings and events." However, they were uninterested in "performing outside work such as gardening or fieldwork" and "snow shoveling and removal." People who felt they were affluent were eager to perform "pick-ups and hospital visits," and the higher educated were more interested in "being a talking partner/consultant in cases of trouble" and "helping with meal preparation/cleaning and laundry." Those involved in highly instrumental activities were interested in "monitoring/safety confirmation," "inviting their neighbors to gatherings and events," "accompanying their neighbors for shopping or serving as a substitute," and "pick-up and hospital visits." Further, except "helping with meal preparation/cleaning and laundry" and "performing outside work such as gardening or fieldwork," people with close relationships with their neighbors were significantly more willing to offer support.Conclusion The characteristics of older people willing to support others depended on the type of lifestyle support required. This finding could help in the recruitment and facilitation of older people willing to offer lifestyle support.
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http://dx.doi.org/10.11236/jph.67.12_860DOI Listing
February 2021

[Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching].

Nihon Koshu Eisei Zasshi 2020 ;67(10):752-762

Tokyo Metropolitan Institute of Gerontology.

Objectives To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults.Methods Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1 : 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model).Results The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio=0.51, 95% confidence interval [CI]=0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio=0.36, 95%CI=0.11-1.21, P=0.099; LTC cost per unit follow-up period: cost ratio=0.36, 95%CI=0.11-1.12, P=0.076).Conclusions These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.
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http://dx.doi.org/10.11236/jph.67.10_752DOI Listing
February 2021

Associations of older adults' physical activity and bout-specific sedentary time with frailty status: Compositional analyses from the NEIGE study.

Exp Gerontol 2021 Jan 9;143:111149. Epub 2020 Nov 9.

Division of Public Health, Department of Infectious Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata City, Niigata 951-8510, Japan.

Aim: To examine associations of intensity-specific physical activity and bout-specific sedentary time with frailty status among Japanese community-dwelling older adults, taking into account the interrelationships of these behaviors.

Methods: Participants were 511 community-dwelling older adults. Physical activity and sedentary time were assessed using a tri-axial accelerometer. Frailty status (frail, pre-frail, or robust) was determined, based on the phenotypic model and used established criteria for Japanese older adults. Associations with frailty status of intensity-specific physical activity and bout-specific sedentary behavior (SB) time were examined using compositional data analysis, adjusted for potential confounders.

Results: Participants included 13 (2.6%) who were frail, 234 (45.8%) pre-frail, and 264 (51.6%) who were robust. For the frail and pre-frail, the proportion of time spent in moderate-to-vigorous physical activity (MVPA) was less than for those who were robust. Frail older adults has larger proportion of time spent in prolonged (≥30 min/bouts) sedentary behavior (SB), and less in short-bout (<30 min/bout) SB, compared to the robust. No statistically-significant differences in the proportion of time spent in light-intensity physical activity was found across frailty levels.

Conclusion: Pre-frail and frail older adults spend proportionally less time in MVPA and more time in prolonged SB, compared with those who were robust. These findings need to be confirmed by evidence from larger and more-diverse study samples and by evidence from prospective studies, in order to better understand whether or not avoiding prolonged periods of sitting could be a potential strategy for preventing frailty among community-dwelling older adults.
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http://dx.doi.org/10.1016/j.exger.2020.111149DOI Listing
January 2021

Workplace and community social capital and burnout among professionals of health and welfare services for the seniors: A multilevel analysis in Japan.

J Occup Health 2020 Jan;62(1):e12177

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Objective: Despite the potential of the social capital approach in preventing burnout, there is sparse evidence of its contextual effect. This study aimed to reveal the contextual association of workplace and community social capital on burnout among professionals of health and welfare services for seniors in Japan.

Methods: We collected data from a cross-sectional questionnaire survey for all health and welfare professionals working in Community Comprehensive Support Centers (CCSCs) in the central Tokyo area in 2015. We assessed burnout using the Japanese version of the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalization, and reduced personal accomplishment. We prepared social capital items regarding workplace (the CCSC the participants belonged to) and community (the current catchment area of the CCSC). We aggregated individual responses of workplace and community social capital within each CCSC to create group-level workplace and community social capital indicators.

Results: Among the 1771 questionnaires distributed, we analyzed 1110 from 211 CCSCs. Multilevel analysis showed that higher group-level workplace social capital was significantly associated with lower scores of all three subscales after adjusting for covariates. Moreover, we found a significant association between greater group-level community social capital and lower scores of depersonalization and reduced personal accomplishment.

Conclusion: Working in workplaces and communities with higher social capital is related to lower burnout. The findings suggest that strategies to enhance the social capital of their workplace and community would be beneficial in the prevention of burnout among professionals in the field of health and social welfare.
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http://dx.doi.org/10.1002/1348-9585.12177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603434PMC
January 2020

National prevalence of frailty in the older Japanese population: Findings from a nationally representative survey.

Arch Gerontol Geriatr 2020 Aug 9;91:104220. Epub 2020 Aug 9.

Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.

Background: Japan has the largest aging population in the world, thus, a focus on frailty is important in clinical geriatric practice. Using a nationally representative sample, this study provided national estimates of the prevalence of frailty among community-dwelling older Japanese people. We also examined variations in the prevalence by sociodemographic characteristics, health conditions, and geographical regions.

Methods: Data came from the National Survey of the Japanese Elderly in 2012. The data were collected using a home visit and face-to-face interviews with trained interviewers. The sample consisted of 2206 adults aged ≥65 years. We used the widely accepted definition of physical frailty phenotype and calculated weighted estimates of the prevalence of frailty.

Results: Overall estimated prevalence was 8.7 % (7.5 %-9.9 %) for frail, 40.8 % (38.7 %-42.9 %) for prefrail, and 50.5 % (48.4 %-52.6 %) for robust. Frailty was more prevalent in older groups, women, and those with lower socioeconomic status, which was measured by education and household income. Frail people tended to have worse health. We also observed a regional variation: frailty prevalence tended to be higher in eastern than western Japan.

Conclusions: This study provides important evidence on the prevalence of frailty in older Japanese people and found substantial disparities by sociodemographic characteristics, health conditions, and geographical regions.
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http://dx.doi.org/10.1016/j.archger.2020.104220DOI Listing
August 2020

Changes in rural older adults' sedentary and physically-active behaviors between a non-snowfall and a snowfall season: compositional analysis from the NEIGE study.

BMC Public Health 2020 Aug 17;20(1):1248. Epub 2020 Aug 17.

Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata City, 951-8510, Japan.

Background: Levels of physical activity change throughout the year. However, little is known to what extent activity levels can vary, based on accelerometer determined sedentary and physically-active time. The aim of this longitudinal study was to examine older adults' activity changes from a non-snowfall season to a subsequent snowfall season, with consideration of the co-dependence of domains of time use.

Methods: Participants were 355 older Japanese adults (53.1% women, aged 65-84 years) living in a rural area of heavy snowfall who had valid accelerometer (Active style Pro HJA-750C) data during non-snowfall and snowfall seasons. Activity was classified as sedentary behavior (SB), light-intensity PA (LPA), and moderate-to-vigorous PA (MVPA). Compositional changes from the non-snowfall to the snowfall season were analyzed using Aitchison's perturbation method. The ratios of each component in the composition, such as [SBsnow/SBnon-snow, LPAsnow/LPAnon-snow, MVPAsnow/MVPAnon-snow] for seasonal changes, were calculated and were then divided by the sum of these ratios.

Results: In men, the percentages of time spent in each activity during the non-snowfall/snowfall seasons were 53.9/64.6 for SB; 40.8/31.6 for LPA; and 5.3/3.8 for MVPA; these corresponded to mean seasonal compositional changes (∆SB, ∆LPA, ∆MVPA) of 0.445, 0.287, and 0.268 respectively. In women, the percentages of time spent in each activity during the non-snowfall/snowfall seasons were 47.9/55.5 for SB; 47.9/41.0 for LPA; and 4.2/3.5 for MVPA; these corresponded to mean seasonal compositional changes (∆SB, ∆LPA, ∆MVPA) of 0.409, 0.302, and 0.289 respectively. The degree of seasonal change was greatest in men.

Conclusions: In older adults, activity behaviors were changed unfavorably during snowfall season, particularly so for men. The degree of seasonal change was greatest for SB. Development of strategies to keep rural older adults active during the snowfall season may be needed for maintaining a consistently-active lifestyle for their health.
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http://dx.doi.org/10.1186/s12889-020-09343-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433168PMC
August 2020

[School students' greeting behavior and its association with their community attachment and helping behavior].

Nihon Koshu Eisei Zasshi 2020 ;67(7):452-460

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.

Objectives Many local governments and elementary and junior high schools in Japan have conducted a "greeting campaign". This has been done in order to activate communication among local residents, and to instill public spirit and sociability in students' minds. However, few studies have explored the significance of greeting campaigns. The present study investigates greeting in neighborhoods and its relationship with students' spontaneous greeting behavior. The study also seeks to understand the quantity of greeting in daily life and its association with a student's community attachment and helping behavior.Methods A self-completion questionnaire survey was conducted with 1,346 students studying in the fourth and higher grades at elementary schools, and 1,357 students in the first and second grade at junior high schools. There were 2,692 valid respondents. We performed the following analyses using the data of elementary school students and junior high school students separately. A partial correlation analysis was conducted wherein gender and grade were introduced as control variables. This analysis tested the correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord. A path analysis that tested the relationship between students' greeting behavior, their attachment to residential areas, and helping behavior was also conducted.Results The results of the partial correlation analysis revealed that there was a positive correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord, regardless of gender and grade. Moreover, the results of the path analysis revealed that the frequency of being greeted was positively associated with community attachment and that the frequency of students' spontaneous greeting behavior was positively associated not only with community attachment but also with helping behavior. The goodness of model fit was high for both the data of elementary school students as well as the data of junior high school students.Conclusion We found that exchanging greetings with surrounding people in daily life enhanced students' attachment to the community. In particular, we showed that students' spontaneous greeting behavior led to their helping behavior, which supports the significance of recommending greeting at home, school, or in the local community. Since there was a correlation between the frequency of being greeted and the frequency of greeting willingly, we consider that actions of surrounding adults become important to help students acquire spontaneous greeting behavior.
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http://dx.doi.org/10.11236/jph.67.7_452DOI Listing
September 2020

Working for only financial reasons attenuates the health effects of working beyond retirement age: A 2-year longitudinal study.

Geriatr Gerontol Int 2020 Aug 3;20(8):745-751. Epub 2020 Jul 3.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Japan.

Aim: The health benefits of paid employment in late life are understood, but they might vary according to work motives. We examined the health effects of employment among older adults, focusing on motivation.

Methods: We carried out a 2-year longitudinal survey from 2013 (baseline) to 2015 (follow up). Among 7608 older adults, the analysis included 1069 who completed both surveys and were employed at baseline. Work motives were assessed using a questionnaire. Participants were assigned to groups based on their responses: (i) financial reasons; (ii) motivation other than financial reasons; and (iii) both financial and non-financial reasons. Self-rated health, mental health and higher-level functional capacity were evaluated as health outcomes.

Results: There were group differences in baseline demographic variables and health status; those with financial reasons had lower socioeconomic status and worse mental health. Multivariable logistic regression analysis showed that compared with older workers with non-financial reasons, those with financial reasons were more likely to decline in self-rated health (OR 1.42; 95% CI 1.00-2.03) and higher-level functional capacity (OR 1.55; 95% CI 1.16-2.07), which was independent of potential covariates, including socioeconomic status. However, no differences were evident between those with only non-financial reasons and those having both financial and non-financial reasons.

Conclusions: We found that the participants who worked only for financial rewards had reduced health benefits through working in old age. A prolonged working life among older workers can contribute to maintaining health and can be enhanced by non-financial reasons, such as finding meaning in life and social contact. Geriatr Gerontol Int 2020; 20: 745-751.
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http://dx.doi.org/10.1111/ggi.13941DOI Listing
August 2020

as a Socio-Cultural Determinant of Cognitive Function among Older Japanese People: Findings from the NEIGE Study.

Int J Environ Res Public Health 2020 06 22;17(12). Epub 2020 Jun 22.

Division of International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.

(social appearance) is a Japanese concept that describes a person's sense of implicit societal pressure to conform to social norms. However, evidence of a relationship between and health outcomes is sparse. This study examined the association between and cognitive function among community-dwelling older Japanese people. Baseline data were obtained from the Neuron to Environmental Impact across Generations (NEIGE) study conducted in 2017; 526 randomly sampled community-dwelling individuals aged 65-84 years living in Tokamachi, Niigata Prefecture, Japan were analyzed. The 12-item Sekentei Scale was used to assess . Cognitive function levels were evaluated with the Japanese version of Mini-Mental State Examination (MMSE-J; ranging from 0-30). Approximately 10% and 25% had cognitive decline and mild cognitive impairment, respectively (MMSE-J scores of ≤23 and 24-26, respectively). Multinomial logistic regression analysis showed that both high and low levels of were associated with lower cognitive function, particularly mild cognitive impairment, after adjusting for sociodemographic factors, health behaviors, health conditions, and genetic factors. The current findings suggest that a moderate level of consciousness is beneficial for cognitive health, and that could be an important socio-cultural factor affecting cognitive function.
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http://dx.doi.org/10.3390/ijerph17124480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345683PMC
June 2020

A qualitative study on the reasons for solitary eating habits of older adults living with family.

PLoS One 2020 8;15(6):e0234379. Epub 2020 Jun 8.

Institute of Gerontology, The University of Tokyo, Tokyo, Japan.

Eating alone while living with family members is a risk factor for mental health decline in old age. However, little is known as to why older adults choose to eat alone, even with family present. This study therefore aimed to explore reasons for older adults eating alone despite living with family members, using a qualitative approach. Fifteen people aged 65 years and older (11 men and 4 women) who were eating alone while living with family members were included in the study. These individuals were selected from the participants of the Kashiwa cohort study conducted in 2016. Individual interviews were conducted using an open-ended format. All interviews were recorded and transcribed. The data were further thematically analyzed using a qualitative software package, NVivo 11. We extracted six themes as reasons for eating alone and hypothesized interactions among these themes. The extracted themes were: "age-related changes," "solo-friendly environment," "family structure changes," "time lag for eating," "bad relationships with family members" and "routinization." To assess interactions, the themes were categorized as "background factors," "triggers," and "stabilizers." The aforementioned themes could lead to the development and sustained behavior of eating alone among older adults living with family members. As most themes describe conditions that are likely to remain static, it may not be realistic to encourage such individuals to begin eating with family members. The promotion of meals with neighbors or friends could be effective in alleviating the negative consequences of eating alone.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234379PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279577PMC
August 2020

[Concept analysis of "Gojo" (mutual help)].

Nihon Koshu Eisei Zasshi 2020 ;67(5):334-343

Division of Health Sciences, Tohoku University Graduate School of Medicine.

Objective The purpose of this study is to redefine "Gojo" (mutual help) among residents and explore measures to develop it Gojo in the integrated community care system. In 2000, long-term care insurance accelerated Japan's movement toward an aging society, thus increasing the importance of Gojo. This study aims to clarify the conceptual definition it has come to acquire in recent years and explore ways it can be developed in comprehensive community systems.Methodology Rodger's evolutionary concept analysis was utilized in the study. A keyword research was done using the term "Gojo" in the Japan Medical Abstracts Society (Ichushi Web) and CiNii Articles databases. The search period was from 2000 to 2016 (search date: August 30, 2016) and the database search formula was set to "Gojo/TA". Thirty documents were selected through random sampling and a total of 32 documents were selected for analysis, including landmark documents. A qualitative analysis was conducted on three frameworks: attributes (i.e., characteristics of Gojo), antecedents (i.e., factors affecting Gojo), and consequences (i.e., expected results for Gojo). These three frameworks represent how Gojo is used, the events occurring before it, and the events resulting from it, respectively.Results The characteristics of Gojo were found to include "experiences of empathy toward residents' daily need for support," "awareness about the residents' efforts to support each other," and "interaction among residents who support other's daily needs." The factors affecting Gojo were identified to be "the need for daily life support beyond what self-help, social solidarity care, and governmental care can provide"; "interchange among residents"; "sharing needs for daily life support among residents"; and "a resident-led public system that promotes mutual support." Gojo's expected results were "a solution for residents' needs of daily support"; "promotion of self-help awareness"; "providing them with a role to enhance their purpose in life"; and "encouraging exchanges and relations between them."Conclusion Gojo was defined as "the interaction between local residents who support their daily needs, have an empathic experience of the need for daily life support, and have the desire to support each other." In addition, the following points were suggested as measures necessary to expand Gojo. The residents must have sympathy for other residents who need daily life support, understand the benefits of supporting each other, and have a public support system, even if Gojo is led by the residents.
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http://dx.doi.org/10.11236/jph.67.5_334DOI Listing
September 2020

Association Between Overtime-Working Environment and Psychological Distress Among Japanese Workers: A Multilevel Analysis.

J Occup Environ Med 2020 08;62(8):641-646

Shinyo Healthy Companies Corporation (Dr Ishida); Institute of Gerontology, The University of Tokyo, Tokyo (Dr Murayama); and Teikyo University Graduate School of Pubic Health (Dr Fukuda), Japan.

Objective: The study aims to examine the association between overtime-working environment (OWE) and individual psychological distress among Japanese workers.

Methods: Data of 7786 workers from 101 companies in Japan were analyzed. Psychological distress was assessed through a 29-item questionnaire. The OWE was evaluated by calculating the proportion of workers whose monthly overtime was 45 hours or more in a workplace. Multilevel logistic regression was used.

Results: As 10% increase in the OWE was associated with a 16% higher risk of individual psychological distress after adjustment of individual covariates, including overtime working hours. Cross-level interaction showed that the risk was varied depending on individual overtime working hours.

Conclusions: OWE was associated with the psychological distress of workers. It is necessary to create a non-OWE at workplaces to prevent psychological distress for workers.
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http://dx.doi.org/10.1097/JOM.0000000000001920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409773PMC
August 2020

Healthy lifestyle behaviors and transitions in frailty status among independent community-dwelling older adults: The Yabu cohort study.

Maturitas 2020 Jun 18;136:54-59. Epub 2020 Apr 18.

Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Frailty is a dynamic condition that can worsen or improve. Although previous studies have identified demographic and intrinsic factors associated with transitions in frailty status, less evidence is available regarding associations with daily activities. This longitudinal study examined associations of behavioral factors with incident frailty, adverse events (e.g. residence in a nursing home, hospitalization, and death), and frailty improvement among older adults. The analysis included data from 3,769 independent older adults aged 65 years or more (mean age, 76.3 ± 7.2years; proportion of frail participants, 30.1%) from the Yabu cohort study (baseline, 2012; follow-up, 2017). The Kaigo-Yobo Checklist, a standardized questionnaire, was used to assess frailty status (non-frail or frail) and seven behavioral factors: farming, shopping, exercise, eating habit, intellectual activity, social participation, and smoking. At the 5-year follow-up survey, the proportions of participants transitioning from non-frail to frail, from non-frail to incident adverse events, from frail to non-frail, and from frail to incident adverse events were 16.8%, 13.9%, 15.2%, and 50.1%, respectively. In the analysis of non-frail participants, farming, exercise, intellectual activity, and social participation were associated with lower odds of becoming frail and experiencing adverse events. In the analysis for frail participants, farming, intellectual activity, and social participation were significantly associated with improvement in frailty status, and farming, shopping, and social participation were associated with lower odds of incident adverse events. These findings suggest that farming, healthy daily activities, and social participation help improve and prevent frailty/adverse events.
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http://dx.doi.org/10.1016/j.maturitas.2020.04.007DOI Listing
June 2020

Socioeconomic Differences in Trajectories of Functional Capacity Among Older Japanese: A 25-Year Longitudinal Study.

J Am Med Dir Assoc 2020 06 18;21(6):734-739.e1. Epub 2020 Apr 18.

Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan.

Objectives: There is limited research on long-term changes in functional capacity among older Japanese, who differ significantly from their counterparts in Western, developed nations. This study aimed to identify distinct trajectories of functional capacity over a 25-year period and to explore socioeconomic differences in trajectory-group membership probabilities, using a national sample of older Japanese.

Design: Longitudinal panel study with 8 observation points from 1987 to 2012.

Setting And Participants: The data came from the National Survey of the Japanese Elderly, which consisted of 6193 samples of community-dwelling Japanese aged 60 years and older at baseline.

Methods: Functional capacity measure included basic and instrumental activities of daily living. Group-based mixture models were used for data analysis.

Results: Among participants aged 60 to 74 years at baseline, 4 trajectories were identified: minimal disability (80.3%), late-onset disability (11.6%), early-onset disability (6.2%), and moderate disability (1.9%). Those aged ≥75 years at baseline experienced higher levels of disability but somewhat parallel trajectories, including minimal disability (73.3%), early-onset disability (11.2%), moderate disability (11.3%), and severe and worsening disability (4.2%). Lower socioeconomic status, including education and household income, was associated with a higher risk of experiencing trajectories of poorer functional capacity among those aged 60 to 74 years, but no such association existed among those aged ≥75 years.

Conclusions And Implications: We found that approximately 70% to 80% of older Japanese maintained healthy functional capacity over time. Although we could not follow those who dropped out during the observation period, this study provided useful evidence that socioeconomic disparities in functional health converge with age. Our findings inform the design of health policies and interventions aiming to maintain functional health among older adults with diverse socioeconomic backgrounds. In particular, public policies aiming to reduce socioeconomic disparities should be emphasized to promote healthy aging.
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http://dx.doi.org/10.1016/j.jamda.2020.02.012DOI Listing
June 2020

Role of Social Support in the Relationship Between Financial Strain and Frequency of Exercise Among Older Japanese: A 19-year Longitudinal Study.

J Epidemiol 2021 Apr 18;31(4):265-271. Epub 2020 Apr 18.

Graduate School of Engineering, The University of Tokyo.

Background: Previous studies have reported that financial strain has deleterious effects on healthy behaviors. Moreover, social support is expected to mitigate these effects, but few studies have investigated the effects of exercise; thus, the investigation can deepen our understanding of the relationship between social support and physical activity/exercise. We examined the relationship between financial strain and frequency of exercise, and the role of social support in this relationship in old age.

Methods: Data came from a 19-year longitudinal study conducted between 1987 and 2006 of Japanese adults aged 60 or more with up to seven repeated observations. Frequency of exercise was assessed using a four-point scale. Financial strain was measured using the responses to three questions related to financial condition. This study considered both emotional and instrumental supports. Covariates included demographic and socioeconomic factors, health behaviors, and health condition.

Results: The analysis included 3,911 participants. The results of a generalized estimation equation model showed that among females, greater financial strain in the previous wave was associated with reduced frequency of exercise (b = -0.018; 95% confidence interval, -0.032 to -0.004), and that as financial strain increased, those who received more instrumental support engaged in less exercise than those who received less support (b = -0.009; 95% confidence interval, -0.017 to -0.002). These relationships were not observed among males.

Conclusion: This study provides evidence that financial strain is negatively correlated with frequency of exercise among older females. In addition, instrumental support is negatively correlated with frequency of exercise among females under financial strain.
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http://dx.doi.org/10.2188/jea.JE20190248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940977PMC
April 2021

Effectiveness of peer counseling, social engagement, and combination interventions in improving depressive symptoms of community-dwelling Filipino senior citizens.

PLoS One 2020 1;15(4):e0230770. Epub 2020 Apr 1.

Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Introduction: Little is known about community-based interventions for geriatric depression in low-resource settings. This study assessed the effectiveness of 3-month-duration interventions with peer counseling, social engagement, and combination vs. control in improving depressive symptoms of community-dwelling Filipino senior citizens.

Methods: We conducted an open (non-blinded), non-randomized trial of senior citizens at risk for depression. Three different 3-month interventions included peer counseling (n = 65), social engagement (n = 66), and combination (n = 65) were compared with the control group (n = 68). We assessed geriatric depression, psychological resilience, perceived social support, loneliness, and working alliance scores at baseline and three months after the intervention. This trial was registered with ClinicalTrials.gov, identifier: NCT03989284.

Results: Geriatric depression score over three months significantly improved in all intervention groups (control as reference). Significant improvements were also seen in psychological resilience and social support. Not all interventions, however, significantly improved the loneliness score. The combination group showed the largest effect of improving depressive symptoms (d = -1.33) whereas the social engagement group showed the largest effect of improving psychological resilience (d = 1.40), perceived social support (d = 1.07), and loneliness (d = -0.36) among senior citizens.

Conclusion: At the community level, peer counseling, social engagement, and combination interventions were effective in improving depressive symptoms, psychological resilience, and social support among Filipino senior citizens. This study shows that it is feasible to identify senior citizens at risk for depression in the community and intervene effectively to improve their mental health. Further studies are required to target loneliness and investigate the long-term benefits of the interventions.

Clinical Trial: ClinicalTrials.gov: NCT03989284.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230770PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112231PMC
July 2020

Efficacy of a Community Health Worker-Based Intervention in Improving Dietary Habits Among Community-Dwelling Older People: A Controlled, Crossover Trial in Japan.

Health Educ Behav 2020 02;47(1):47-56

Tohoku University, Miyagi, Japan.

Community health workers (CHWs), often called "health promotion volunteers" in Japan, are individuals who act as a natural helping resource in the community. This study tested the efficacy of a CHW-based intervention to improve dietary habits among community-dwelling older people in Japan, using a controlled, crossover design. Seventy-eight people aged 65 to 74 years with poor dietary variety living in four administrative districts in Hikone City (Shiga Prefecture, Japan) were nonrandomly allocated to an immediate-intervened group (IIG; = 41) or a delayed-intervened group (DIG; = 37). Participants joined a biweekly, four-session program (120 minutes/session), comprising "CHW drama-style lectures," "group discussion among participants and CHWs," "tasting of dishes," and "take-home practical activities." For the initial 2-month period, the IIG received the intervention and the DIG did not. The groups were crossed over for the subsequent 2-month period. The primary outcome measure was participants' dietary variety score (score range: 0-10). The dietary variety score in the IIG significantly increased in the initial 2-month period compared with the DIG (effect size 1.60 points; 95% confidence interval: 0.75, 2.45). The intervention had a similar effect in the DIG in the subsequent 2-month period. Moreover, an analysis within the IIG showed that the intervention effects persisted for at least 2 months after the intervention. The CHW-based intervention improved dietary habits among older people. Our findings provide evidence that a CHW-based natural helping approach is a possible solution to promote healthy aging in the community.
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http://dx.doi.org/10.1177/1090198119891975DOI Listing
February 2020

[Characteristics and challenges of health promotion volunteer organizations in Japan: Findings from a national municipality survey].

Nihon Koshu Eisei Zasshi 2019 ;66(11):712-722

Department of Health Welfare Office, Oita Prefecture.

Objective Various types of health promotion organizations exist in Japan, including volunteer organizations that promote healthy diets, health improvement, and maternal and child health. Health promotion volunteers, trained and recruited by municipalities, provide counseling and education on various health concerns to community members. A previous study on the effect of these activities and the organizational challenges demonstrated a decrease in the number of volunteer members. The present study aimed to identify the organizational characteristics and challenges of health promotion volunteer work in Japan to gain insight into volunteer recruitment and organizational management.Methods A questionnaire was sent to 1,873 Japanese municipalities via e-mail or postal mail (excluding Tokyo's 23 wards). For cities of cabinet order, a questionnaire was sent to each borough in the municipality. Data were collected from February to March 2017. The survey was used to collect data on four types of health promotion volunteer organizations: healthy diet (organizations of volunteers who were shokuseikatsu kaizen suishinin), health improvement (organizations of volunteers who were kenkozukuri suishinin), and two types promoting maternal and child health (organizations of volunteers who were boshihoken suishinin and aiikuhan). We asked about the presence or absence of the organization type, year of establishment, number of members, the largest age group, recruitment methods, etc. Twelve organizational challenges were measured with a six-item Likert scale (from 1="strongly agree" to 6="strongly disagree"). Proportions of active members in the volunteer organization ranged from 0% to 10%.Results Eight hundred eight municipalities responded to the survey (valid responses: 805, valid response rate: 43.1%). The presence or absence of the four types of volunteer organizations differed among the municipalities. The most common type was organizations of volunteers who were shokuseikatsu kaizen suishinin (84.7% municipalities), followed by kenkozukuri suishinin (64.3%), boshihoken suishinin (26.4%), and aiikuhan (10.1%). The total ratio of responses of "strongly agree," "agree," and "somewhat agree" about the organizational challenges, including "The organization cannot find new members easily" and "The participants are always the same people," was commonly more than 50% for the four types of volunteer organizations. The challenges, including "Many do not enjoy what they do," "For many volunteers, participation is limited due to work and family obligations," and "The goal of the activities is not widely shared among volunteers," were significantly correlated to the proportion of active members in the volunteer organization for all four types of organizations.Conclusion This study revealed that organizational characteristics differed among the four types of health promotion volunteer organizations; however, many of the organizational challenges were found to be common throughout Japanese municipalities.
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http://dx.doi.org/10.11236/jph.66.11_712DOI Listing
February 2020

Factors relating to social isolation in urban Japanese older people: A 2-year prospective cohort study.

Arch Gerontol Geriatr 2020 Jan - Feb;86:103936. Epub 2019 Sep 18.

Research Team for Social Participation and Health Promotion, Japan.

Purpose: We analyzed the data from a 2-year prospective-cohort survey to identify factors relating to new incidences of social isolation and recovery from social isolation in community-dwelling older people.

Materials And Methods: We conducted a longitudinal study (2013-2015) involving 2657 older residents of Iriarai, Japan. A chi-square test, an independent t-test, and logistic regression analysis with imputed data were conducted to examine categorical data, continuous variables, and factors relating to social isolation, respectively.

Principal Results: The results suggested that the factors that predicted future social isolation included being a man, being older, living with others, having a decline in mental health, having a lower frequency of going out, and not participating in community groups. On the other hand, being younger, having a higher level of mental health, having a higher frequency of going out, and participating in community groups were identified as factors that predicted participants' recovery from social isolation.

Major Conclusions: Some demographic, mental, and social factors could relate to new incidences of social isolation and recovery from social isolation in community-dwelling older people. As aging is an irreversible phenomenon, and there is a limit to preventing all disorders, either building a safety net or introducing exchange programs to prevent social isolation are important interventions for older people.
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http://dx.doi.org/10.1016/j.archger.2019.103936DOI Listing
July 2020

Does community social capital buffer the relationship between educational disadvantage and cognitive impairment? A multilevel analysis in Japan.

BMC Public Health 2019 Nov 1;19(1):1442. Epub 2019 Nov 1.

Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.

Background: This study explored the relationship between community social capital and cognitive impairment, with a focus on the buffering role of community social capital in the association between educational disadvantage and cognitive impairment in community-dwelling older adults in Japan.

Methods: We used data from two population-based, cross-sectional surveys targeting people aged ≥65 years in a suburban city of the Tokyo metropolitan area (n = 897; 49.8% men; average age = 74.4 years). Social capital included social support (emotional and instrumental support) and the strength of social networks (neighborly ties). To create district-level social capital indicators, we aggregated individual responses on social capital within each district. The Mini-Mental State Examination, Japanese version was used for the assessment of cognitive function.

Results: Using multilevel logistic regression analysis, we found that lower amounts of district-level emotional and instrumental support were associated with a greater likelihood of cognitive impairment among men. For women, district-level emotional support was associated with a greater likelihood of cognitive impairment. Additionally, a strong district-level social network buffered the relationship between low education and cognitive impairment in both sexes.

Conclusions: Community social capital appears to have a protective role in determining cognitive function in old age. Our findings may facilitate the development of new community-based strategies to combat dementia.
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http://dx.doi.org/10.1186/s12889-019-7803-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825339PMC
November 2019

Associations of Sedentary and Physically-Active Behaviors With Cognitive-Function Decline in Community-Dwelling Older Adults: Compositional Data Analysis From the NEIGE Study.

J Epidemiol 2020 Nov 26;30(11):503-508. Epub 2019 Oct 26.

Division of International Health, Niigata University Graduate School of Medical and Dental Sciences.

Background: Physical activity can help to protect against cognitive decline in older adults. However, little is known about the potential combined relationships of time spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with indices of cognitive health. We examined the cross-sectional associations of objectively-determined sedentary and physically-active behaviors with an indicator of cognitive function decline (CFD) in older adults.

Methods: A randomly-recruited sample of 511 Japanese older adults (47% male; aged 65-84 years) wore a tri-axial accelerometer for 7 consecutive days in 2017. Cognitive function was assessed by interviewers using the Japanese version of Mini-Mental State Examination, with a score of ≤23 indicating CFD. Associations of sedentary and physically-active behaviors with CFD were examined using a compositional logistic regression analysis based on isometric log-ratio transformations of time use, adjusting for potential confounders.

Results: Forty one (9.4%) of the participants had an indication of CFD. Activity compositions differed significantly between CFD and normal cognitive function (NCF); the proportion of time spent in MVPA was 39.1% lower, relative to the overall mean composition in those with CFD, and was 5.3% higher in those with NCF. There was a significant beneficial association of having a higher proportion of MVPA relative to other activities with CFD. LPA and SB were not associated with CFD when models were corrected for time spent in all activity behaviors.

Conclusions: Larger relative contribution of MVPA was favorably associated with an indicator of CFD in older adults.
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http://dx.doi.org/10.2188/jea.JE20190141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557173PMC
November 2020

Leadership and Peer Counseling Program: Evaluation of Training and Its Impact on Filipino Senior Peer Counselors.

Int J Environ Res Public Health 2019 10 24;16(21). Epub 2019 Oct 24.

Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.

Senior volunteers represented a significant, mostly untapped lay resource of informal social care. In this study, we evaluated the effectiveness of the training program on improving senior volunteers' competency toward peer counseling, and explored its impact on their well-being after three months of the program implementation. We conducted a pre- and post-intervention analysis among 60 senior volunteers aged 60-82 years. They participated in 40 h of training and performed weekly peer counseling home visits for three months. We evaluated the program using survey questionnaires, trainer observation and debriefing, and focus group discussions. After the training, peer counselors showed a significant improvement ( < 0.001) in knowledge (17.1 versus 22.3) and skills (17.0 versus 17.9). All of them met the minimum required passing level of 70% for the knowledge test, and their overall performance was satisfactory as rated by two independent trainers. After three months, peer counselors showed a significant improvement ( < 0.001) in their subjective well-being ( = 0.69) and depressive symptoms ( = -0.67). Filipino senior volunteers could be trained to serve as peer counselors in their communities. This program improved their competency and well-being. Future research is warranted to determine whether the provision of counseling by them will affect the health outcomes of the target population.
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http://dx.doi.org/10.3390/ijerph16214108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861991PMC
October 2019

Sekentei and objectively-measured physical activity among older Japanese people: a cross-sectional analysis from the NEIGE study.

BMC Public Health 2019 Oct 22;19(1):1331. Epub 2019 Oct 22.

Division of International Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata City, Niigata, 951-8510, Japan.

Background: The concept of sekentei (social appearance), defined as sensitivity about one's reputation, reflects Japanese behavioral principles and involves pressure to conform to social norms, particularly among people living in rural areas. However, data regarding the relationship between sekentei and health behaviors are sparse. In this study, we examined the relationship between sekentei and objectively-measured physical activity among community-dwelling older people in Japan.

Methods: We used data from the Neuron to Environmental Impact across Generations Study (NEIGE Study), which is a prospective cohort study of randomly-sampled community-dwelling individuals aged 65-84 years living in Tokamachi City, Niigata Prefecture, Japan. The baseline survey was conducted in 2017 and included 527 independent older people. We analyzed the baseline data cross-sectionally. To measure activity behaviors, participants wore a tri-axial accelerometer for seven consecutive days. Physically active individuals were defined based on the World Health Organization recommendation guidelines on physical activity. Sekentei was measured using the 12-item Sekentei Scale (score range: 12-60).

Results: After excluding 15 people for whom we had three or fewer days of valid accelerometer-assessed activity data, we used data from 512 participants in our analysis (average 73.4 years old; 46.9% men). Physically active individuals made up 22.3% of the sample, and the proportion of physically active men was higher than that of women. A logistic regression analysis showed that higher levels of sekentei were inversely associated with physical activity after adjusting for demographic factors, socioeconomic status, and health conditions (odds ratio [95% confidence interval]: 0.58 [0.36-0.91] for every 10-point increase in the Sekentei Scale score). This association was stronger in women than in men (0.66 [0.34-1.26] for men and 0.51 [0.26-1.00] for women).

Conclusions: Our findings indicate that an individual's sense of sekentei may be an important socio-cultural factor affecting their level of physical activity. Culturally appropriate approaches may be beneficial in addressing insufficient physical activity in older adults.
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http://dx.doi.org/10.1186/s12889-019-7702-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805600PMC
October 2019

Gender Difference in the Association Between Subjective Socioeconomic Mobility Across Life Course and Mortality at Older Ages: Results From the JAGES Longitudinal Study.

J Epidemiol 2020 Nov 12;30(11):497-502. Epub 2019 Oct 12.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health.

Background: Socioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages.

Methods: Participants were 16,690 community-dwelling adults aged 65-100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants' vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: 'persistently high', 'downward mobility', 'upward mobility', and 'persistently low'. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality.

Results: Mortality HRs for the 'downward' group were 1.37 (95% confidence interval [CI], 1.08-1.74) among men and 1.27 (95% CI, 0.94-1.71) among women in comparison with the 'persistently high' group. Compared to the 'persistently low' group, the HRs for the 'upward' group were 0.54 (95% CI, 0.35-0.83) among women and 0.91 (95% CI, 0.73-1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression.

Conclusions: 'Downward' mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.
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http://dx.doi.org/10.2188/jea.JE20190083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557171PMC
November 2020

Unmet Needs and Coping Mechanisms Among Community-Dwelling Senior Citizens in the Philippines: A Qualitative Study.

Int J Environ Res Public Health 2019 10 4;16(19). Epub 2019 Oct 4.

Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.

The Philippine government is facing a burden of improving health and social services for both the growing elderly and young population. The extent of discussion on aging issues and concerns, however, is minimal at best. Therefore, this study aimed to examine the perceptions of unmet needs and to explore the coping mechanisms of senior citizens across local stakeholders in an urban area in the Philippines. In this qualitative study, we collected data using focus group discussions among senior citizens ( = 4) and health providers ( = 4) as well as in-depth interviews among local administrators ( = 7). We analyzed the data through thematic analysis using the social determinants of health as the theoretical framework. We used qualitative research software NVivo10® to track the coding and manage the data. Four major themes related to unmet needs emerged in the analyses: (1) financial security, (2) health care services, (3) age-friendly environment, and (4) family support. Senior citizens responded either positively or negatively to cope with the challenges associated with aging. The government must then revisit existing national policies to address their unmet needs. Actions should be taken to strengthen positive coping and modifying the negative coping mechanisms, with a particular focus on community and family interventions.
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http://dx.doi.org/10.3390/ijerph16193745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801835PMC
October 2019

[Development and effectiveness of care preventive supporter training programs based on a literature review].

Nihon Koshu Eisei Zasshi 2019 ;66(9):582-592

Institute of Gerontology, The University of Tokyo.

Objective Many preventive care supporter (e.g. kaigo-yobo supporter) training programs, conducted to train community residents, are developed by municipalities. However, it is not necessary that only municipalities can train people effectively or efficiently. In this paper, we initially reviewed the relevant literature and clarified the definitions of concepts like "program contents" and "evaluation indicators," while also planning our own training programs. Later, we developed a program based on the review and examined the results.Methods The literature of the training program was examined, and the training program was developed based on the result. Four researchers and three public health nurses from a community general support center, in the Otsuchi Town of Iwate Prefecture, developed a training program from June to September 2017. The training program developed was then conducted from October to November 2017. To evaluate the participants' satisfaction with the program, a self-report survey was conducted. To evaluate the outcomes of the program, we measured their degree of comprehension of their community's challenges, before and after the program.Results The training program was divided into two parts following the literature review. In the first part, the content of the supporters' activities following the program was determined (Type A), and, in the second, the same content was evaluated by the participants within the program (Type B). Type A consisted of various aspects including both concrete knowledge and skills needed to conduct care preventiveactivities after the program. In Type B, there were many aspects-including both lectures and exercises-that aimed to increase the participants' awareness of community challenges, as well as inspection to learn about pioneering activities which helped them consider concrete care preventive activities following the program. In Otsuchi Town, we found it to be imperative for participants to consider how to respond to various situations and accordingly plan the training program for use in Type B. To evaluate the results, 12 participants were analyzed. Participants included two men and ten women, with an average age of 71.4±10.0 years [range: 53-88]. Comprehension levels of community challenges (3.1→4.1, P=0.046), as well as the confidence to actively involve themselves in their own preventive care strategies (3.4→4.0, P=0.035), significantly increased after involvement in the program. However, their confidence to work for community preventive care support groups (3.1→3.5, P=0.227) did not increase significantly.Conclusion We clarified certain viewpoints, such as the purpose, content, and evaluation indices of community care training programs, by reviewing the relevant literature. Based on the discovered viewpoints, we were then able to obtain certain results through implementing our own training programs, thereby significantly increasing participant comprehension and confidence levels.
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http://dx.doi.org/10.11236/jph.66.9_582DOI Listing
January 2020