Publications by authors named "Katsunori Kondo"

275 Publications

[Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data].

Nihon Koshu Eisei Zasshi 2021 Aug 6. Epub 2021 Aug 6.

Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology.

Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3) higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.
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http://dx.doi.org/10.11236/jph.21-056DOI Listing
August 2021

General health checks and incident dementia: A six-year follow-up study of community-dwelling older adults in Japan.

Prev Med 2021 Aug 1;153:106757. Epub 2021 Aug 1.

Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.

General health checks to detect cardiovascular risk factors form part of routine health care in many countries. Cardiovascular disease and dementia share a number of risk factors; however it remains unclear whether general health checks can reduce the incidence of dementia. We used longitudinal data from the Japan Gerontological Evaluation Study with up to 6.4 years follow-up (from 2010 to 2016). A total of 31,012 disability-free adults aged 65-74 were included. The outcome variable was dementia onset certified under the national long-term care insurance system. The treatment variable was defined as having health checks within the past 12 months prior to the baseline survey in 2010. After multiple imputation, we performed propensity score matching (PSM) to exclude off-support individuals who were the least likely to have health checks. We also performed inverse probability treatment weighting (IPTW) to estimate the effect of the treatment if everyone within the population was compliant to health checks. The hazard ratios for dementia onset among those reporting health checks within the previous year was 0.89 (95% confidence interval (CI): 0.78, 1.02) in the PSM analysis and 0.84 (95% CI: 0.75, 0.95) in the IPTW analysis. We then estimated the effect of health checks on 5-year incident dementia. The 5-year cumulative incidence difference based on the PSM analysis was -0.0046 (95%CI: -0.0101, 0.0009), while that based on the IPTW analysis was -0.0046 (95%CI, -0.0090, -0.0002). The PSM and IPTW approaches yielded similar findings that the incidence of dementia was lower among people having health checks.
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http://dx.doi.org/10.1016/j.ypmed.2021.106757DOI Listing
August 2021

Association between community-level social capital and frailty onset among older adults: a multilevel longitudinal study from the Japan Gerontological Evaluation Study (JAGES).

J Epidemiol Community Health 2021 Aug 2. Epub 2021 Aug 2.

Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Background: Little is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data.

Methods: This prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan.

Results: In total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants' mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status.

Conclusions: Living in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.
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http://dx.doi.org/10.1136/jech-2021-217211DOI Listing
August 2021

Community-Level Participation in Volunteer Groups and Individual Depressive Symptoms in Japanese Older People: A Three-Year Longitudinal Multilevel Analysis Using JAGES Data.

Int J Environ Res Public Health 2021 07 14;18(14). Epub 2021 Jul 14.

School of Health Innovation, Kanagawa University of Human Services, Kawasaki 210-0821, Japan.

Background: The current study aimed to investigate the contextual effect of volunteer group participation on subsequent depressive symptoms in older people.

Methods: We analyzed the longitudinal data of 37,552 people aged 65 years and older in 24 municipalities surveyed in the Japan Gerontological Evaluation Study. Volunteer group participation of older people was assessed in 2013 by one question and depressive symptoms were assessed by the Geriatric Depression Scale 15 in 2016. To investigate a contextual effect, we aggregated individual-level volunteer group participation by each residence area as a community-level independent variable. We conducted a two-level multilevel Poisson regression analysis using the Random Intercepts and Fixed Slopes Model.

Results: The average proportion of community-level volunteer group participation was 10.6%. The results of the Poisson regression analysis showed that community-level volunteer group participation reduced the risk for the onset of depressive symptoms by 13% with a 10 percentage point increase in participation, after adjusting for sex, age, population density, total annual sunshine hours and annual rainfall (incident rate ratio, 0.87; 95% confidence interval, 0.78-0.98).

Conclusions: Older people living in areas with higher volunteer group participation had a lower risk of developing depressive symptoms regardless of whether or not they participated in a volunteer group.
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http://dx.doi.org/10.3390/ijerph18147502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306052PMC
July 2021

Types of social networks and starting leisure activities in later life: A longitudinal Japan Gerontological Evaluation Study (JAGES).

PLoS One 2021 15;16(7):e0254828. Epub 2021 Jul 15.

Center for Advanced Intelligence Project, RIKEN, Chuo-ku, Tokyo, Japan.

Considering beneficial effects of leisure activities in later life on well-being and health, we investigated which type of social network among older adults is associated with starting their participation in leisure activities. We used data from a longitudinal Japan Gerontological Evaluation Study (JAGES) conducted in Japan every three years from 2010 to 2016. We extracted types of social networks of older adults who did not participate in leisure activities in 2013 and responded to items related to social networks (n = 3436) relying on latent class analysis to examine changes in leisure activity participation over a three-year period within each latent class while controlling for participants' activity in 2010. As a result, we identified five latent classes of social networks: the Neighborhood network, the Restricted network, which is characterized by limited social contacts, the Colleagues network, the Same-Interest network, and the Diverse network, from the most to the least prevalent. We found that members of the Neighborhood (Cohen's d = 0.161) and Same-Interest networks (d = 0.660) were significantly more likely to, and members of the Diverse (d = 0.124) and Colleague networks (d = 0.060) were not significantly more likely to start leisure activities than those in the Restricted network. Furthermore, we found that lower age, better mental health, and higher education level were positively associated with starting participation in leisure activities in some latent classes. Horticulture or gardening was most likely to be chosen across all latent classes. Supporting the formation of social networks facilitating leisure activities, and recommending activities that were likely to be selected could be one solution for getting and keeping older adults active.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254828PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282000PMC
July 2021

Estimating the impact of sustained social participation on depressive symptoms in older adults.

Epidemiology 2021 Jun 21. Epub 2021 Jun 21.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Hungtington Ave, Boston, MA, USA. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Hungtington Ave, Boston, MA, USA. Department of Epidemiology and Biostatistics, University of California, 550 16 St 2 floor, San Francisco, CA, USA. Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, 9 Bow Street, Cambridge, MA, USA. Department of Sociology and Work Science, University of Gothenburg, 405 30, Gothenburg, Sweden. The Division of Data Science and Artificial Intelligence, the Department of Computer Science and Engineering, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, USA. Teikyo University, Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan. Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan. Department of Health Education and Health Sociology, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. Center for Preventive Medical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Japan. Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, Japan.

Background: Social participation has been suggested as a means to prevent depressive symptoms. However, it remains unclear whether a one-time boost suffices or whether participation needs to be sustained over time for long-term prevention. We estimated the impacts of alternative hypothetical interventions in social participation on subsequent depressive symptoms among older adults.

Methods: Data were from a nationwide prospective cohort study of Japanese older adults aged 65 years or older (n=32 748). We analyzed social participation 1) as a baseline exposure from 2010 (approximating a one-time boost intervention) and 2) as a time-varying exposure from 2010 and 2013 (approximating a sustained intervention). We defined binary depressive symptoms in 2016 using the Geriatric Depression Scale. We used the doubly robust targeted maximum likelihood estimation to address time-dependent confounding.

Results: The magnitude of the association between sustained participation and the lower prevalence of depressive symptoms was larger than the association observed for baseline participation only (e.g., Prevalence Ratio, PR, for participation in any activity: 0.83; 95% CI: 0.79, 0.88 vs. 0.90; 0.87, 0.94). For activities with a lower proportion of consistent participation over time (e.g., senior clubs), there was little evidence of an association between baseline participation and subsequent depressive symptoms, while an association for sustained participation was evident (e.g., PR for senior clubs: 0.96; 0.90, 1.02 vs. 0.88; 0.79, 0.97). Participation at baseline but withholding participation in 2013 was not associated with subsequent depressive symptoms.

Conclusions: Sustained social participation may be more strongly associated with fewer depressive symptoms among older adults.
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http://dx.doi.org/10.1097/EDE.0000000000001395DOI Listing
June 2021

Social capital and pneumococcal vaccination (PPSV23) in community-dwelling older Japanese: a JAGES multilevel cross-sectional study.

BMJ Open 2021 06 17;11(6):e043723. Epub 2021 Jun 17.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Objective: Inequalities exist between the 23-valent pneumococcal polysaccharide vaccination (PPSV23) rate in each municipality among Japanese older adults. Exploring individual-level and community-level intervenable factors is necessary to improve the vaccination rates. We examined the associations between community-level and individual-level social capital and the PPSV23 vaccination among older Japanese adults using multilevel Poisson regression analyses.

Design: Cross-sectional study.

Setting: We used data from the Japan Gerontological Evaluation Study, conducted between 3 October 2016 and 10 January 2017 in 631 districts, 39 municipalities and 18 prefectures.

Participants: The target population comprised persons aged 65 years or older who are physically and cognitively independent (that is, not certified as needing long-term care). Further, 180 021 older adults from 39 Japanese municipalities were enrolled.

Primary Outcome Measure: The primary outcome was the PPSV23 vaccination among the Japanese older adults aged 65 years or older who did not have physical or cognitive disabilities.

Results: After adjusting for municipality-, community-, individual-levels effects with multiple imputation, 137 075 individuals who participated in one/more of the civic participation (participation of social groups), social cohesion (social tie), or reciprocity (mutual exchange of social support) were significantly associated with more vaccinations than those without the three social capitals among the 137 075 older adults (13.0% (95% CI 11.0% to 14.9%), 5.0% (95% CI 2.4% to 7.6%) or 33.9% (95% CI23.6% to 44.2%) increase, respectively, p>0.001 for all). The rich (≥+1 SD) community-level civic participation was significantly associated with 3.4% increase [95% CI 0.02% to 6.78%, p<0.05] of the PPSV23 vaccination among the older adults compared to those with the poor or standard one.

Conclusions: Older adults with one/more of the three social capitals at the both levels received more PPSV23 vaccinations than those without those social capitals. Therefore, fostering of those social capitals may improve the inequality of the PPSV23 vaccination rate among older adults in each municipality.
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http://dx.doi.org/10.1136/bmjopen-2020-043723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212184PMC
June 2021

Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers.

Arch Gerontol Geriatr 2021 Sep-Oct;96:104455. Epub 2021 Jun 2.

Department of Frailty, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan; Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Purpose: To determine whether frailty associated factors differ between community dwellers and older adult patients with rheumatoid arthritis (RA).

Methods: We used the cross-sectional data for patients with RA from the RA epidemiological quality-of-life study (n = 210, mean age 71.8 ± 3.7 years) and community dwellers from the Japan Gerontological Evaluation Study (n = 53,255, mean age 71.7 ± 4.0 years). Frailty status was assessed using the Kihon Checklist (KCL), and the primary outcome was frailty (KCL score ≥8 points). Information on predictor variables, including age, sex, marital status, educational level, body mass index (BMI), drinking and smoking status and social participation were obtained from a standardized questionnaire. We employed Poisson regression to calculate the prevalence ratio (PR) of frailty according to its predictors.

Results: We found frailty in 37.6% of the patients with RA and 15.7% of the community dwellers. In the multivariate models, BMI and social participation were independently associated with frailty in patients with RA (BMI <18.5: PR, 1.62; 95% confidence interval [CI] 1.09-2.41. BMI ≥25.0: PR, 1.81; 95% CI 1.20-2.71. Active social participation: PR, 0.61; 95% CI 0.42-0.87) and community dwellers (BMI <18.5: PR, 1.77; 95% CI 1.67-1.88. BMI ≥25.0: PR, 1.27; 95% CI 1.22-1.33. Active social participation: PR, 0.46; 95% CI 0.44-0.48). All other predictors were significantly associated with frailty in the community dwellers.

Conclusion: Maintaining appropriate body weight and participating in social activities are important for preventing frailty in patients with RA as well as community dwellers.
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http://dx.doi.org/10.1016/j.archger.2021.104455DOI Listing
September 2021

Do Community Social Capital and Built Environment Associate With Homebound in Older Adults? The JAGES Niigata Study.

J Epidemiol 2021 Jun 11. Epub 2021 Jun 11.

Center for Preventative Medical Sciences, Chiba University.

Background: Homebound status is one of the most important risk factors associated with functional decline and long-term care in older adults. Studies show that neighborhood built environment and community social capital may be related to homebound status. This study aimed to clarify the association between homebound status for community-dwelling older adults and community environment-including social capital and neighborhood built environment-in rural and urban areas.

Methods: We surveyed people aged 65 years and older residing in three municipalities of Niigata Prefecture, Japan, who were not certified as requiring long-term care. The dependent variable was homebound status; explanatory variables were community-level social capital and neighborhood built environment. Covariates were age, sex, household, marital status, socioeconomic status, instrumental activities of daily living, the Geriatric Depression Scale-15, self-rated health, number of diseases under care, and individual social capital. The association between community social capital or neighborhood built environment and homebound status, stratified by rural/urban areas, was investigated using multilevel logistic regression analysis.

Results: Among older adults (n = 18,099), the homebound status prevalence rate was 6.9% in rural areas and 4.2% in urban areas. The multilevel analysis showed that, in rural areas, fewer older adults were homebound in communities with higher civic participation and with suitable parks or pavements for walking and exercising. However, no significant association was found between community social capital or neighborhood built environment and homebound status for urban older adults.

Conclusions: Community social capital and neighborhood built environment were significantly associated with homebound status in older adults in rural areas.
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http://dx.doi.org/10.2188/jea.JE20200154DOI Listing
June 2021

Community social support and onset of dementia in older Japanese individuals: a multilevel analysis using the JAGES cohort data.

BMJ Open 2021 06 3;11(6):e044631. Epub 2021 Jun 3.

Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.

Objective: Recently, there has been an increase in the number of people with dementia. However, no study has examined the association between community-level social support and the onset of incident dementia using multilevel survival analysis.

Design: A prospective cohort study.

Participants And Setting: We analysed data pertaining to 15 313 (7381 men and 7932 women) community-dwelling adults aged 65 years or older who had not accessed long-term care insurance and were living in Aichi Prefecture (seven municipalities) in Japan.

Primary And Secondary Outcome Measures: The association between community-level social support and onset of incident dementia was examined using the Japan Gerontological Evaluation Study, a prospective cohort study introduced in Japan in 2003. Incident dementia was assessed using Long-term Care Insurance records spanning 3436 days from the baseline survey.

Results: During the 10-year follow-up, the onset of incident dementia occurred in 1776 adults. Among older people, a 1% increase in community-level social support (in the form of receiving emotional support) was associated with an approximately 4% reduction in the risk of developing dementia, regardless of socio-demographic variables and health conditions (HR=0.96; 95% CI=0.94 to 0.99).

Conclusions: Receiving community-level social support in the form of emotional support is associated with a lower risk of developing incident dementia.
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http://dx.doi.org/10.1136/bmjopen-2020-044631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183266PMC
June 2021

Dental prosthetic treatment reduced the risk of weight loss among older adults with tooth loss.

J Am Geriatr Soc 2021 Sep 3;69(9):2498-2506. Epub 2021 Jun 3.

Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Objectives: Weight loss is a critical health issue in older adults. Oral function is essential for nutrient intake and can be restored using dental prosthetic treatments in patients with tooth loss. This study aimed to investigate the relationship between tooth loss and weight loss among the older adults and to evaluate the magnitude of its risk reduction by dental prosthetic treatment.

Design: Three-year follow-up longitudinal study based on a self-reported questionnaire.

Setting: Community-dwelling older adults in Japan.

Participants: Adults aged 65 and older (n = 53,690).

Measurements: We used >10% weight loss during follow-up, the number of remaining teeth, and the use of dental prostheses as the outcome variable, exposure variable, and mediator, respectively. We fitted the logistic regression model including possible confounders and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) of the controlled direct effect (CDE) at the level of use or nonuse of the dental prosthesis based on a causal mediation analysis framework. Additionally, we calculated the proportion eliminated by the dental prosthesis.

Results: The mean age of participants was 72.6 years (1 SD = 5.5), and 47.4% were males. About 5.8% (n = 3132) of them experienced >10% weight loss during the follow-up. Weight loss was observed in 6.8% of the participants with 0-19 remaining teeth and in 4.3% of them with ≥20 remaining teeth. The CDE of 0-19 remaining teeth was greater when no one used dental prosthesis (OR = 1.41; 95% CI = 1.26-1.59) compared with that when all participants used dental prosthesis (OR = 1.26; 95% CI = 1.08-1.46). This indicated that dental prosthesis decreased the risk of weight loss by 37.3%.

Conclusion: Our study revealed that tooth loss increased the risk of clinically critical levels of weight loss among community-dwelling older adults. However, this risk was reduced by dental prosthetic treatment.
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http://dx.doi.org/10.1111/jgs.17279DOI Listing
September 2021

Differences in Cumulative Long-Term Care Costs by Community Activities and Employment: A Prospective Follow-Up Study of Older Japanese Adults.

Int J Environ Res Public Health 2021 05 19;18(10). Epub 2021 May 19.

Center for Preventive Medical Sciences, Chiba University, Chiba 260-0856, Japan.

We evaluated differences in the cumulative benefit costs of public long-term care (LTC) insurance services by employment status and frequency of community activities. A baseline survey was conducted on functionally independent older people from 12 municipalities as a nationwide survey from 2010 to 2011. Employment status was dichotomized, and community activity was assessed based on the frequency of participation in hobbies, sports clubs, or volunteering. We followed the respondents' LTC service costs over a period of 6 years using public LTC claim records ( = 46,616). We adopted a classical linear regression analysis and an inverse probability weighting estimation with multiple imputation for missing values. Compared with non-participation in each community activity, the cumulative LTC costs among individuals who participated in hobbies or sports group activities at least twice a week were 1.23 (95% confidence interval: 0.73-1.72) to 1.18 (0.68-1.67) thousand USD lower per person over the 6-year period (28.7% to 30.1% lower, respectively). Similarly, the costs for employed persons were 0.55 (0.20-0.90) to 0.64 (0.29-0.99) thousand USD per person lower than among retirees (14.5% to 16.9% lower). Promoting employment opportunities and frequent participation in community activities among older adults may help reduce future LTC costs by around 20% as a result of extending healthy longevity.
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http://dx.doi.org/10.3390/ijerph18105414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158700PMC
May 2021

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES.

Int J Environ Res Public Health 2021 05 9;18(9). Epub 2021 May 9.

Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan.

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.
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http://dx.doi.org/10.3390/ijerph18095004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125926PMC
May 2021

Watching sports and depressive symptoms among older adults: a cross-sectional study from the JAGES 2019 survey.

Sci Rep 2021 May 19;11(1):10612. Epub 2021 May 19.

Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan.

The current study investigated the relationship between the frequency of watching sports and depressive symptoms among older adults. This study used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide mail survey of 21,317 older adults. Depressive symptoms were defined as a Geriatric Depression Scale score of ≥ 5. Participants were queried regarding the average frequency at which they watched sports on-site and via TV/Internet over the past year. Among the 21,317 participants, 4559 (21.4%) had depressive symptoms, while 4808 (22.6%) and 16,576 (77.8%) watched sports on-site and via TV/Internet at least once a year, respectively. Older adults who watched sports on-site a few times/year (prevalence ratio, 0.70; 95% confidence interval, 0.65-0.74) or 1-3 times/month (0.66, 0.53-0.82) were less likely to have depressive symptoms compared to non-spectators after adjusting for frequency of playing sports, exercise activities, and other potential confounders. Meanwhile, a dose-response relationship was confirmed for watching via TV/Internet (prevalence ratio of 0.86, 0.79, and 0.71 for a few times/year, 1-3 times/month, and ≥ 1 time/week, respectively). This study suggested that watching sports on-site or via TV/Internet, regardless of whether they regularly engage in sports, may reduce the risk of depressive symptoms among older adults.
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http://dx.doi.org/10.1038/s41598-021-89994-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134456PMC
May 2021

Adverse Childhood Experiences and Dementia: Interactions With Social Capital in the Japan Gerontological Evaluation Study Cohort.

Am J Prev Med 2021 08 11;61(2):225-234. Epub 2021 May 11.

Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.

Introduction: This study investigated whether individual-level social capital modifies the association between adverse childhood experiences and dementia onset.

Methods: A 3-year follow-up (2013-2016) was conducted among participants who were physically and cognitively independent in the Japan Gerontological Evaluation Study. Dementia incidence for 16,821 participants was assessed through the public long-term care insurance system. Adverse childhood experiences before age 18 years and social capital were assessed using a self-report questionnaire at baseline in 2013. A total of 7 adverse childhood experiences were assessed: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. To assess social capital's mediating effect, 3 individual social capital items were measured (community trust, reciprocity, and attachment). The overall social capital score was categorized as low (<10th percentile), middle (10th-90th percentile), or high (>90th percentile). Data were analyzed in 2020.

Results: During the 3-year follow-up, 652 dementia cases occurred. Those with more adverse childhood experiences had a greater risk of dementia. Stratification by social capital score showed that the hazard ratio of ≥3 adverse childhood experiences (versus none) was 3.25 (95% CI=1.73, 6.10) among those with low social capital and 1.19 (95% CI=0.58, 2.43) among those with middle social capital. Among those with ≥3 adverse childhood experiences and high social capital, no dementia cases were observed.

Conclusions: Among older adults in Japan, adverse childhood experiences were associated with increased dementia incidence only for those with low social capital.
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http://dx.doi.org/10.1016/j.amepre.2021.01.045DOI Listing
August 2021

Examining the associations between oral health and social isolation: A cross-national comparative study between Japan and England.

Soc Sci Med 2021 05 18;277:113895. Epub 2021 Apr 18.

Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8510, Japan; Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo-machi, Aoba Ward, Sendai City, Miyagi, 980-8574, Japan. Electronic address:

In Western countries, the most important part of the face in communication is the mouth, whereas it is the eyes in Asian countries; thus oral health could be more important in social interactions in Western countries. Our aim was to examine differences in the association between oral health status and social isolation among older people by comparing Japan and England. We used cross-sectional information obtained from adults aged 65+ in two ongoing prospective cohort studies: The Japan Gerontological Evaluation Study (JAGES, N = 120,195) and the English Longitudinal Study of Ageing (ELSA, N = 3,958). The dependent variable, social isolation score (SIS) was calculated from five factors (marital status, social support from children, social support from family, social support from friends, and social participation). The independent variables were self-reported number of remaining teeth (0, 1-9, 10-19, ≥20) and denture use (≥20 teeth, 10-19 teeth with denture, 10-19 teeth without denture, 0-9 teeth with denture, 0-9 teeth without denture), while the covariates in the model were: sex, age, educational attainment, self-rated health, number of comorbidities, household annual equivalized income, mental health status, daily living activities, and smoking status. We examined associations between oral health status and SIS by applying an ordered logit model by country. Compared to England, more Japanese participants were socially isolated (1.4% vs. 5.8%), but fewer were edentulous (13.1% vs. 7.7%). In both countries, poorer oral health further increased the odds of being socially isolated. Pooled analysis of the ordered logit model with an interaction term showed that the association of number of remaining teeth with SIS was stronger in edentulous participants and in England (odds ratio = 1.50, 95% Confidence interval:1.26-1.80). In both countries, oral health was associated with social isolation; this association could be stronger in England than in Japan.
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http://dx.doi.org/10.1016/j.socscimed.2021.113895DOI Listing
May 2021

Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study).

Sci Rep 2021 Apr 12;11(1):7966. Epub 2021 Apr 12.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chuo-ku, Chiba, 260-8670, Japan.

Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66-2.22] and PR 1.80, 95% CI [1.42-2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.
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http://dx.doi.org/10.1038/s41598-021-86854-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041848PMC
April 2021

Engaging in musical activities and the risk of dementia in older adults: A longitudinal study from the Japan gerontological evaluation study.

Geriatr Gerontol Int 2021 Jun 6;21(6):451-457. Epub 2021 Apr 6.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Aim: Leisure cognitive activities are suggested to reduce the risk of dementia. Herein, we aimed to investigate the prospective association between engaging in different musical activities and the risk of dementia among Japanese older adults.

Methods: Longitudinal data of 52 601 participants aged ≥65 years from the Japan Gerontological Evaluation Study were analyzed. Musical activities in the form of playing a musical instrument, practicing karaoke and choir or folk singing were assessed using a questionnaire, while dementia was diagnosed using the standardized dementia scale of the long-term care insurance system. The Cox regression was used to obtain the hazard ratios and 95% confidence intervals (CIs) for incident dementia according to engagement in musical activities.

Results: Compared with engaging in no musical activities at all, the hazard ratios engaging in one and more than one musical activity, after 5.8 years of a median follow-up period, were 0.94 (95% CI 0.82-1.07) and 0.59 (95% CI 0.32-1.10) in men versus 0.79 (95% CI 0.69-0.90) and 0.89 (95% CI 0.63-1.26) in women, respectively. Playing a musical instrument and practicing karaoke, compared with no musical activities at all, were associated with a faintly decreased risk of dementia in men and a significantly decreased risk of dementia in women; hazard ratios 0.70 (95% CI 0.45-1.02) and 0.90 (95% CI 0.79, 1.04) in men versus 0.75 (95% CI 0.58-0.98) and 0.77 (95% CI 0.68-0.89) in women, respectively.

Conclusion: Engaging in musical activities, especially playing a musical instrument and practicing karaoke, was associated with a reduced risk of dementia among Japanese older women. Geriatr Gerontol Int 2021; 21: 451-457.
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http://dx.doi.org/10.1111/ggi.14152DOI Listing
June 2021

Social participation and mortality according to company size of the longest-held job among older men in Japan: A 6-year follow-up study from the JAGES.

J Occup Health 2021 Jan;63(1):e12216

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Objectives: The purpose of this study was to examine the relationship between social participation (type/pattern) and mortality according to company size of the longest-held job among older men in Japan who have worked in the company.

Methods: Longitudinal data from the Japan Gerontological Evaluation Study were used in this study. Functionally independent individuals aged 65 years and older in Japan were surveyed. Work and community organizations (local community, hobbies, and sports) were used as social participation. A Cox proportional hazards model was used to calculate mortality hazard ratios.

Results: Analysis was carried out on 19 260 participants. A total of 2870 deaths occurred during the 6-year follow-up period. Those in companies with 49 or fewer employees had the highest prevalence of work participation and the lowest participation in any community organization. Regardless of company size, the mortality risk was significantly lower for participants in any social participation (eg, the hazard ratio for participation in a hobby organization among those with a company size of 49 employees or fewer was 0.74, 95% CI: 0.65-0.85) compared to nonparticipants whose company size was 49 or fewer employees.

Conclusions: In Japan, although older men who have worked for small companies may have fewer benefits, their social participation may reduce their mortality risks. To avoid increasing health inequalities, it is necessary to create an environment in which they are more likely to participate in social activities.
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http://dx.doi.org/10.1002/1348-9585.12216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012407PMC
January 2021

Increased frequency of participation in civic associations and reduced depressive symptoms: Prospective study of older Japanese survivors of the Great Eastern Japan Earthquake.

Soc Sci Med 2021 05 8;276:113827. Epub 2021 Mar 8.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Rationale: Few studies have examined whether changes in participation in civic associations can mitigate depressive symptoms among older disaster survivors.

Objectives: We examined prospectively the association between changes in participation in civic associations and changes in depressive symptoms among older survivors of the 2011 Great Eastern Japan Earthquake.

Methods: We analyzed questionnaire-based survey data on pre- and post-disaster participation in civic associations and depressive symptoms compiled for 3567 respondents aged 65 years and above. Changes in these symptoms were assessed using a 15-item Geriatric Depression Scale (GDS) as a continuous variable for 2010 and 2013. We investigated four types of civic associations: sports, hobby, voluntary groups, and senior citizens' clubs. Changes in participation were calculated by subtracting the participation frequency measured in 2010 from that measured in 2013. Applying 95% confidence intervals, we used linear regression models with imputation to estimate the age- and sex-adjusted and multivariate-adjusted standardized coefficients.

Results: The survivors' GDS scores increased by 0.13 points on average between the pre-disaster and post-disaster periods. Average changes in the participation frequencies of respondents in each group were respectively +0.36 days/year, -5.63 days/year, +0.51 days/year, and -1.45 days/year. Increased frequencies of participation in the sports and hobby groups were inversely associated with changes in GDS scores (B = -0.003, Cohen's f = 0.10, P = 0.01 and B = -0.002, Cohen's f = 0.08, P = 0.04, respectively). The associations did not differ depending on the experience of housing damage caused by the disaster. In addition, we did not observe a significant association between changes in participation frequencies for voluntary groups or senior citizens' clubs and changes in GDS scores after multivariable adjustment.

Conclusions: Depressive symptoms of older adults post-disaster may be mitigated through increased frequency of participation in sports and hobby groups; yet, civic participation did not mitigate the adverse impact of disaster experiences on mental health.
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http://dx.doi.org/10.1016/j.socscimed.2021.113827DOI Listing
May 2021

Association between social isolation and depression onset among older adults: a cross-national longitudinal study in England and Japan.

BMJ Open 2021 03 18;11(3):e045834. Epub 2021 Mar 18.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Objective: Social isolation is a risk factor for depression in older age. However, little is known regarding whether its impact varies depending on country-specific cultural contexts regarding social relationships. The present study examined the association of social isolation with depression onset among older adults in England, which has taken advanced measures against social isolation, and Japan, a super-aged society with a rapidly increasing number of socially isolated people.

Design: Prospective longitudinal study.

Setting: We used data from two ongoing studies: the English Longitudinal Study of Ageing (ELSA) and the Japan Gerontological Evaluation Study (JAGES).

Participants: Older adults aged ≥65 years without depression at baseline were followed up regarding depression onset for 2 years (2010/2011-2012/2013) for the ELSA and 2.5 years (2010/2011-2013) for the JAGES.

Primary Outcome Measure: Depression was assessed with eight items from the Centre for Epidemiologic Studies Depression Scale for the ELSA and Geriatric Depression Scale for the JAGES. Multivariable logistic regression analysis was performed to evaluate social isolation using multiple parameters (marital status; interaction with children, relatives and friends; and social participation).

Results: The data of 3331 respondents from the ELSA and 33 127 from the JAGES were analysed. Multivariable logistic regression analysis demonstrated that social isolation was significantly associated with depression onset in both countries. In the ELSA, poor interaction with children was marginally associated with depression onset, while in the JAGES, poor interaction with children and no social participation significantly affected depression onset.

Conclusions: Despite variations in cultural background, social isolation was associated with depression onset in both England and Japan. Addressing social isolation to safeguard older adults' mental health must be globally prioritised.
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http://dx.doi.org/10.1136/bmjopen-2020-045834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978252PMC
March 2021

The deterioration of oral function and orofacial appearance mediated the relationship between tooth loss and depression among community-dwelling older adults: A JAGES cohort study using causal mediation analysis.

J Affect Disord 2021 05 9;286:174-179. Epub 2021 Mar 9.

Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Division for Regional Community Development, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Miyagi, Japan. Electronic address:

Background: Depression is a major health problem among older adults, for which previous studies have suggested tooth loss as a risk factor. This study examined the mediating effect of oral function and orofacial appearance in the relationship between tooth loss and depression.

Methods: This three-year follow-up longitudinal study was based on a self-reported questionnaire targeting community-dwelling older adults aged ≥65 years. We used the incidence of depressive symptoms during follow-up as the outcome, the number of remaining teeth (≥20/≤19) as the exposure, and the deterioration of oral function and orofacial appearance (speaking, smiling, and eating) as mediators. We fitted the logistic regression model including confounders and calculated the natural indirect effect (NIE), natural direct effect, and the proportion mediated (PM) by the deterioration of oral functions by applying the causal mediation analysis framework.

Results: The mean age of the 8,875 participants was 72.7 years (1SD=5.5) and 48.0% were male. Depressive symptoms developed during follow-up in 11.5% of the participants (n=1,024). The incidence for those with ≤19 and ≥20 remaining teeth was 13.1% and 9.2%, respectively. Total effect of fewer remaining teeth (≤19) on depressive symptoms was OR=1.30 (95%CI=1.12-1.51). Difficulty in speaking (NIE OR=1.03, 95%CI=1.00-1.06, PM=12.4%), problems in smiling (NIE OR=1.04, 95%CI=1.01-1.07, PM=16.9%), and difficulty in chewing (NIE OR=1.05, 95%CI=1.02-1.09, PM=21.9%) significantly mediated the relationship.

Limitation: Selection bias due to dropout.

Conclusion: Deterioration of oral function and orofacial appearance were mediating factors of the mechanism for the relationship between tooth loss and the incidence of depressive symptoms.
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http://dx.doi.org/10.1016/j.jad.2021.02.071DOI Listing
May 2021

Causal Inference in Studying the Long-Term Health Effects of Disasters: Challenges and Potential Solutions.

Am J Epidemiol 2021 09;190(9):1867-1881

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.
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http://dx.doi.org/10.1093/aje/kwab064DOI Listing
September 2021

Neighborhood farm density, types of agriculture, and depressive symptoms among older farmers: a cross-sectional study.

BMC Public Health 2021 03 4;21(1):440. Epub 2021 Mar 4.

Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Floor 2, Science Frontier Laboratory, Yoshida-konoe-cho, Sakyo-ku, Kyotoshi, Kyoto, Japan.

Background: Farmers may have an increased risk for poor mental health. In connection with this, factors specific to the neighborhood environment such as farm density and the type of agriculture, might be important for mental wellbeing. In this study we aimed to clarify the cross-level interaction on depressive symptoms between farm density at the neighborhood level by type of agriculture and the longest occupation of individuals (farmer or non-farmer).

Methods: Data came from the 2016 wave of the Japan Gerontological Evaluation Study (JAGES) that were linked to governmental agricultural data. Information was analyzed from 147,549 respondents aged 65 years or older, residing in 1024 neighborhoods in 39 municipalities. We calculated farm (crop or animal husbandry) density at the neighborhood level, dividing the number of agricultural management entities by the population. Three-level (individual, neighborhood, and municipality) Poisson regression analysis was used to calculate the prevalence rate ratios of depressive symptoms.

Results: The prevalence of depressive symptoms was higher among individuals whose longest occupation was farmer compared to non-farmer. The estimated probability of depressive symptoms by a cross-level interaction analysis showed that among farmers of both genders, those who were residing in neighborhoods where the farm density was low had a higher prevalence of depressive symptoms, regardless of the type of agriculture. The slope of the relationship between depressive symptoms and animal husbandry farm density varied by occupation, with a higher prevalence of depressive symptoms observed in male farmers compared to male non-farmers.

Conclusions: The high prevalence of depressive symptoms among farmers in neighborhoods with a low farm density may reflect a scarcity of formal and informal social support in such communities. The health effects of the neighborhood environment on farmers, such as farm density, which may vary by the type of agriculture, should be further researched.
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http://dx.doi.org/10.1186/s12889-021-10469-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934400PMC
March 2021

Dispositional Optimism and Disaster Resilience: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami.

Soc Sci Med 2021 03 13;273:113777. Epub 2021 Feb 13.

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

Objective: Dispositional optimism - the general belief that good things will happen - is considered a key asset for the preservation of mental health after a traumatic life event. However, it has been hypothesized that in extreme situations such as major disasters where positive expectations cannot overcome the grim reality on the ground, being optimistic might be a disadvantage. To test this mismatch hypothesis, this study explores whether higher pre-disaster dispositional optimism is associated with higher posttraumatic stress (PTS) and depressive symptoms among individuals who experienced the 2011 Great East Japan Earthquake and Tsunami.

Methods: Information on optimism was collected from community-dwelling residents aged ≥65 years seven months before the 2011 Earthquake/Tsunami in Iwanuma, a Japanese city located 80-km from the epicenter. Data on disaster-related personal experiences (e.g., loss of relatives or friends/housing damage), as well as depressive and PTS symptoms, were collected during a follow-up survey in 2013, 2.5 years after the earthquake and tsunami. Multiple logistic regression models were utilized to evaluate the associations between disaster experiences, optimism, and depressive/PTS symptoms among 962 participants.

Results: Higher pre-disaster dispositional optimism was associated with lower odds of developing depressive symptoms (OR = 0.78, 95% CI: 0.65 to 0.95) and PTS symptoms (OR = 0.83, 95% CI: 0.69 to 0.99) after the earthquake. Contrary to the mismatch hypothesis, high dispositional optimism buffered the adverse impact of housing damage on depressive symptoms (interaction term coefficient = -0.63, p = 0.0431), but not on PTS symptoms.

Conclusions: In contrast to the mismatch hypothesis, the results suggest that dispositional optimism is a resilience resource among survivors of a disaster.
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http://dx.doi.org/10.1016/j.socscimed.2021.113777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005486PMC
March 2021

Neighborhood Sidewalk Environment and Incidence of Dementia in Older Japanese Adults.

Am J Epidemiol 2021 07;190(7):1270-1280

Sidewalks are indispensable environmental resources for daily life in that they encourage physical activity. However, the proportion of sidewalk coverage is low even in developed countries. We examined the association between neighborhood sidewalk environment and dementia in Japan. We conducted a 3-year follow-up (2010-2013) among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of community-dwelling older adults. We ascertained the incidence of dementia for 76,053 participants from the public long-term care insurance system. We calculated sidewalk coverage (sidewalk area as a percentage of road area) within 436 residential neighborhood units using geographic information systems. Multilevel survival models were used to estimate hazard ratios for the incidence of dementia. During follow-up, 5,310 dementia cases were found. In urban areas, compared with the lowest quartile of sidewalk coverage, the hazard ratio was 0.42 (95% confidence interval: 0.33, 0.54) for the highest quartile, adjusting for individual covariates. After successive adjustments for other neighborhood factors (land slope; numbers of hospitals, grocery stores, parks, railway stations, and bus stops; educational level; and unemployment rate), the hazard ratio remained statistically significant (hazard ratio = 0.71, 95% confidence interval: 0.54, 0.92). Living in a neighborhood with a high level of sidewalk installation was associated with low dementia incidence in urban areas.
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http://dx.doi.org/10.1093/aje/kwab043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245872PMC
July 2021

Predictors of home being the preferred place of death among Japanese older people: JAGES cross-sectional study.

Geriatr Gerontol Int 2021 Apr 16;21(4):345-352. Epub 2021 Feb 16.

Graduate School of Health Care Science, Tokyo Medical and Dental University, Tokyo, Japan.

Aim: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people.

Methods: Cross-sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death.

Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end-of-life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end-of-life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area.

Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345-352.
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http://dx.doi.org/10.1111/ggi.14135DOI Listing
April 2021

Association of pneumococcal and influenza vaccination with patient-physician communication in older adults: A nationwide cross-sectional study from the JAGES 2016.

J Epidemiol 2021 Feb 6. Epub 2021 Feb 6.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University.

Background: Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient-physician communication and whether this variable was associated with increased odds of vaccination.

Methods: We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination.

Results: Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians' listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients' questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination.

Conclusion: The results suggest that promotion of having a family physician, better patient-physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.
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http://dx.doi.org/10.2188/jea.JE20200505DOI Listing
February 2021

Prospective Study of Engagement in Leisure Activities and All-Cause Mortality Among Older Japanese Adults.

J Epidemiol 2021 Feb 6. Epub 2021 Feb 6.

Harvard T.H. Chan School of Public Health.

Background: Engagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities.

Methods: We examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors.

Results: We found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio 0.93; 95% CI, 0.92-0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality.

Conclusions: Although we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.
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http://dx.doi.org/10.2188/jea.JE20200427DOI Listing
February 2021

Longitudinal association between oral status and cognitive decline by fixed-effects analysis.

J Epidemiol 2021 Jan 30. Epub 2021 Jan 30.

Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University.

BackgroundAlthough the feasibility of randomized trials for investigating the long-term association between oral health and cognitive decline is low, deriving causal inferences from observational data is challenging. We aimed to investigate the association between poor oral status and subjective cognitive complaints (SCC) using fixed-effects model to eliminate the confounding effect of unobserved time-invariant factors.MethodsWe used data from Japan Gerontological Evaluation Study (JAGES) which was conducted in 2010, 2013, and 2016. β regression coefficients (95% confidence intervals) were calculated using fixed-effects models to determine the effect of deteriorating oral status on developing SCC. Onset of SCC was evaluated using the Kihon Checklist-Cognitive function score. Four oral status variables were used: awareness of swallowing difficulty, decline in masticatory function, dry mouth, and number of teeth.Results13,594 participants (55.8% women) without SCC at baseline were included. The mean age was 72.4 (SD = 5.1) for men and 72.4 (SD=4.9) for women. Within the 6-year follow-up, 26.6% of men and 24.9% of women developed SCC. The probability of developing SCC was significantly higher when participants acquired swallowing difficulty (β= 0.088; 0.065-0.111 for men, β= 0.077; 0.057-0.097 for women), decline in masticatory function (β=0.039; 0.021-0.057 for men, β= 0.030; 0.013-0.046 for women), dry mouth (β= 0.026; 0.005-0.048 for men, β= 0.064; 0.045-0.083 for women), and tooth loss (β= 0.043; 0.001-0.085 for men, β= 0.058; 0.015-0.102 for women).ConclusionsThe findings suggest that good oral health needs to be maintained to prevent the development of SCC, which increases the risk for future dementia.
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http://dx.doi.org/10.2188/jea.JE20200476DOI Listing
January 2021
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