Publications by authors named "Taishi Tsuji"

61 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

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

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

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

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

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

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

Community-Level Sports Group Participation and Health Behaviors Among Older Non-Participants in a Sports Group: A Multilevel Cross-Sectional Study.

Int J Environ Res Public Health 2021 01 10;18(2). Epub 2021 Jan 10.

Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi 474-8511, Japan.

This study validates the relationship between community-level sports group participation and the frequency of leaving the house and transtheoretical model stages of behavior change for exercise among older individuals who did not participate in a sports group. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study. The proportion of sports group participants at the community level was calculated using the data from 157,233 older individuals living in 1000 communities. We conducted a multilevel regression analysis to examine the relationship between the proportion of sports group participants and the frequency of leaving the house (1 day/week or less) and the transtheoretical model stages of behavior change for exercise. A statistically significant relationship was observed between a high prevalence of sports group participation and lower risk of homeboundness (odds ratio: 0.94) and high transtheoretical model stages (partial regression coefficient: 0.06) as estimated by 10 percentage points of participation proportion. Older individuals, even those not participating in a sports group, living in a community with a high prevalence of sports group participation are less likely to be homebound; they are highly interested and have numerous opportunities to engage in exercise.
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http://dx.doi.org/10.3390/ijerph18020531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827491PMC
January 2021

[Types and number of hobbies and incidence of dementia among older adults: A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES)].

Nihon Koshu Eisei Zasshi 2020 ;67(11):800-810

Faculty of Health and Sport Sciences, University of Tsukuba.

Objectives Dementia prevention is an important issue in the current super-aging society. Previous studies have shown a low risk of dementia in older adults who have hobbies, especially gardening, tourism, and those that are sports-based. However, it is unclear whether the effect of dementia prevention differs according to the specific type and number of hobbies. This study aims to clarify the relationship of dementia onset with the type and number of hobbies practiced by a person.Methods This prospective cohort study conducted between 2010 and 2016 by the Japan Gerontological Evaluation Study surveyed 56,624 functionally independent individuals aged 65 years and over who had non-missing information on age and gender. A total of 49,705 participants who provided valid answers to the question regarding hobbies, and were followed for 365 days or more, were analyzed. The primary outcome of this study was dementia, which was assessed by the nationally standardized dementia scale proposed by the Ministry of Health, Labour, and Welfare of Japan. Explanatory variables were specific types of hobbies practiced by 5% or more of older adults (males: 14 types and females: 11 types) and the number of hobbies an individual engaged in (0~5 types or more). The covariates were basic characteristics, diseases, health behavior, social support, psychology/cognition, and instrumental activities of daily living. Hazard ratios (HRs) were calculated using the Cox proportional hazards model adjusted for a total of 22 variables.Results In total, 4,758 patients (9.6%) developed dementia during the follow-up period. The following hobbies were related to a lower risk of developing incident dementia: a) both in males and females, ground golf (HR: males, 0.80; females, 0.80) and travel (males, 0.80; females, 0.76); b) only in males, golf (0.61), use of a personal computer (0.65), fishing (0.81), and photo shooting (0.83); and c) only in females, handicrafts (0.73), and gardening (0.85). A significant trend was observed indicating that the risk of dementia was lower as the number of hobbies increased for both males and females (males, 0.84; females, 0.78).Conclusion The results of this study suggest that both male and female older adults who engaged in ground golf and travel as a hobby had a lower risk of developing dementia, and the risk decreased as the number of hobbies increased. Providing an environment in which older adults can engage in various hobbies that are associated with less risk of developing dementia, may be an effective measure for preventing dementia.
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http://dx.doi.org/10.11236/jph.67.11_800DOI Listing
February 2021

[Effectiveness of walking point projects with incentives for walking time, physical function, and depression among older people: inverse probability of treatment weighting using propensity scores].

Nihon Koshu Eisei Zasshi 2020 ;67(10):734-744

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

Objectives This study aimed to examine the effectiveness of a walking point project with incentives for increasing walking time, preventing the decline of physical function and worsening depression among older adults.Methods We used data from the Japan Gerontological Evaluation Study, which included subjects aged ≥65 years who lived in Yokohama City in 2013 and 2016. We obtained information on the subjects' participation in the "Yokohama Walking Point (YWP)," a program launched by Yokohama City in 2014, from the 2016 survey data. We excluded individuals with missing data for sex, age, walking time per day (<30, 30-59, 60-89, or ≥90 min/day), physical function (5 physical function category items on the Kihon Checklist), depression (15-item Geriatric Depression Scale), and participation status in the YWP. We used data from 4,509 eligible respondents. Changes in walking time, physical function, and depression were designated as independent variables, and participation status in the YWP was designated as the dependent variable in the multiple regression analysis with inverse probability of treatment weighting (IPTW), after adjusting for demographic variables, socioeconomic status, health status, and behavior.Results Among the total subjects, 758 (16.8%) participated in the YWP. The IPTW method showed that participants in the YWP had significantly higher walking times (B=3.61, 95% CI: 1.04, 6.17), less decline in physical function, and less depression (B=-0.13, 95% CI: -0.23, -0.03; B=-0.21, 95% CI: -0.42, -0.01) than those who did not participate in the YWP.Conclusions Our findings suggest that the YWP, with incentives, effectively increased walking time and prevented worsening of physical function and depression among older adults. The municipality's health point project, based on the number of steps, is a useful population approach for promoting health among older adults.
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http://dx.doi.org/10.11236/jph.67.10_734DOI Listing
February 2021

Cross-national comparison of social isolation and mortality among older adults: A 10-year follow-up study in Japan and England.

Geriatr Gerontol Int 2021 Feb 21;21(2):209-214. Epub 2020 Dec 21.

Center for Well-being and Society, Nihon Fukushi University, Mihama, Japan.

Aim: Existing evidence links social isolation with poor health. To examine differences in the mortality risk by social isolation, and in socio-economic correlates of social isolation, we analyzed large-scale cohort studies in Japan and England.

Methods: Participants were drawn from the Japan Gerontological Evaluation Study (JAGES) and the English Longitudinal Study of Ageing (ELSA). We analyzed the 10-year mortality among 15 313 JAGES participants and 5124 ELSA respondents. Social isolation was measured by two scales, i.e., scoring the frequency of contact with close ties, and a composite measurement of social isolation risk. We calculated the population attributable fraction, and Cox regression models with multiple imputations were used to estimate hazard ratios (HRs) for mortality due to social isolation.

Results: The proportion of those with contact frequency of less than once a month was 8.5% in JAGES and 1.3% in ELSA. Males, older people, those with poor self-rated health, and unmarried people were significantly associated with social isolation in both countries. Both scales showed that social isolation among older adults had a remarkably higher risk for premature death (less frequent contact with others in JAGES: hazard ratio [HR] = 1.18, 95% confidence interval [CI]: 1.05-1.33, in ELSA: HR = 1.27, 95% CI: 0.85-1.89; and high isolation risk score in JAGES: HR = 1.30, 95% CI: 1.12-1.50, in ELSA: HR = 2.05, 95% CI: 1.52-2.73). The population attributable fraction showed less frequent contact with close ties was attributed to about 18 000 premature deaths annually in Japan, in contrast with about 1800 in England.

Conclusions: Negative health impacts of social isolation were higher among older Japanese compared with those in England. Geriatr Gerontol Int 2021; 21: 209-214.
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http://dx.doi.org/10.1111/ggi.14118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898799PMC
February 2021

Elder Abuse and Depressive Symptoms: Which is Cause and Effect? Bidirectional Longitudinal Studies From the JAGES.

J Interpers Violence 2020 Dec 7:886260520967135. Epub 2020 Dec 7.

Chiba University, Chiba, Japan.

Elder abuse is a serious public health concern that increases the risks of negative health outcomes globally. It is well known that abuse in older adults is associated with depression; however, longitudinal studies investigating the causal relationship between these events are scarce. Because the cause precedes the result over time, the temporal relationships between abuse and depression should be verified from each direction. This longitudinal study, therefore, investigated and clarified whether depression causes or results from elder abuse among older Japanese adults. Two longitudinal analyses were conducted using data derived from the Japan Gerontological Evaluation Study. The data were collected in 2010 and 2013 through a mail survey of 1,737 people (983 females, 754 males) across Japan. Of those who did not experience abuse in 2010, 38 (5.0%) males and 53 (5.4%) females newly experienced abuse in 2013. Among respondents who did not have depressive symptoms in 2010, 60 (8.0%) males and 61 (6.2%) females newly reported depressive symptoms in 2013. After adjusting for demographic factors in Analysis 1, people who experienced abuse were 2.28-fold (95% confidence interval [CI] = 1.68-3.09) more likely to have depressive symptoms three years later than those who were not abused. In Analysis 2, respondents who had mild or severe depression in 2010 were 2.23-fold (95% CI = 1.61-3.10) more likely to have experienced abuse after three years than those who did not have depression. After adjusting for several demographic factors, the results showed that abuse can lead to depression and that depression can be a cause of abuse. Therefore, preventing abuse should be considered from both directions.
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http://dx.doi.org/10.1177/0886260520967135DOI Listing
December 2020

Cultural engagement and incidence of cognitive impairment: A six-year longitudinal follow-up of the Japan Gerontological Evaluation Study (JAGES).

J Epidemiol 2020 Sep 19. Epub 2020 Sep 19.

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

Background: Active engagement in intellectually enriching activities reportedly lowers the risk of cognitive decline; however, few studies have examined this association, including engagement in traditional cultural activities. This study aimed to elucidate the types of cultural engagement associated with lower risk of cognitive impairment.

Methods: We examined the association between cultural engagement and cognitive impairment using Cox proportional hazards models in a cohort of 44,985 participants (20,772 males and 24,213 females) aged 65 years or older of the Japan Gerontological Evaluation Study from 2010 to 2016. Intellectual activities (e.g., reading books, magazines, and/or newspapers), creative activities (e.g., crafts and painting), and traditional cultural activities (e.g., poetry composition [haiku], calligraphy, and tea ceremony/flower arrangement) were included among cultural engagement activities.

Results: Over a follow-up period of six years, incident cognitive disability was observed in 4,198 respondents (9.3%). After adjusting for potential confounders such as depression and social support, intellectual activities were protectively associated with the risk of cognitive impairment (hazard ratio, HR for those who read and stated that reading was their hobby: 0.75 [95% confidence interval, CI 0.66-0.85] and those who read but did not consider reading a hobby: 0.72 [95% CI, 0.65-0.80]). Engagement in creative activities was also significantly correlated with lower risk of cognitive impairment (crafts: 0.71 [95% CI, 0.62-0.81] and painting: 0.80 [95% CI, 0.66-0.96]). The association between traditional cultural activities and the risk of cognitive impairment was not statistically significant.

Conclusions: Engagement in intellectual and creative activities may be associated with reduced risk of dementia.
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http://dx.doi.org/10.2188/jea.JE20190337DOI Listing
September 2020

Change in the prevalence of social isolation among the older population from 2010 to 2016: A repeated cross-sectional comparative study of Japan and England.

Arch Gerontol Geriatr 2020 Aug 22;91:104237. Epub 2020 Aug 22.

Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba City, Chiba 260-8670 Japan; Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi 474-8511 Japan.

Objective: To compare the change in the prevalence of social isolation from 2010 to 2016 between older populations in Japan, the most aging and socially isolated country, and England, a country known for advanced social isolation measures.

Methods: Surveys from the Japan Gerontological Evaluation Study (JAGES) and the English Longitudinal Study of Aging (ELSA) included 70,751 and 4134 participants, respectively, aged 65 years or older in 2010 and 94,228 and 4295 participants in 2016. We assessed the social isolation of respondents on a scale from 0 to 5 points based on lack of social interactions with a spouse or partner, children, relatives, or friends and nonparticipation in any organization.

Results: Results of two-way analysis of variance confirmed significant interactions (nation × period) in men and women aged 65-74 years and women aged 75 years or older. In JAGES, all had higher scores in 2016 compared to 2010 (1.64-1.76, 1.28-1.36, and 1.55-1.60 points, respectively). Furthermore, the proportions of those with lack of interaction with relatives increased (52.7%-58.9%, 31.5%-41.1%, and 25.2%39.2%, respectively). In ELSA, women aged 75 years or older demonstrated a significantly lower mean score in 2016 than in 2010 (1.40 vs. 1.21). No significant changes were observed in other groups.

Conclusion: Social isolation among older adults is more severe in Japan than in England. The difference has widened, especially for women and younger older adults. This is attributed to the weakening relationships with relatives in Japan.
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http://dx.doi.org/10.1016/j.archger.2020.104237DOI Listing
August 2020

Association between social isolation and smoking in Japan and England.

J Epidemiol 2020 Aug 8. Epub 2020 Aug 8.

Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry.

Background: Existing evidence suggest that those who are socially isolated are at risk for taking up or continuing smoking. This study investigated country-based differences in social isolation and smoking status.

Methods: We performed a repeated cross-sectional study using two waves of data from two ongoing aging studies: the English Longitudinal Study of Ageing and the Japan Gerontological Evaluation Study. Participants from both studies aged ≥65 years old were included. We applied a multilevel Poisson regression model to examine the association between social isolation and smoking status and adjusted for individual sociodemographic characteristics. We used the social isolation index which comprises the following domains: marital status; frequency of contact with friends, family, and children; and participation in social activities. Interaction terms between each country and social isolation were also entered into the mode.

Results: After exclusion of never smokers, we analyzed 75,905 participants (7,092 for ELSA and 68,813 for JAGES, respectively). Taking ex-smokers as the reference, social isolation was significantly associated with current smoking; the prevalence ratios (PRs; 95% credible intervals [CrIs]) were 1.06 (1.05-1.08) for men and 1.08 (1.04-1.11) for women. Taking Japan as a reference, the interaction term between country and social isolation was significant for both sexes, with increased PRs (95% CrIs) of 1.32 (1.14-1.50) for men and 1.30 (1.11-1.49) for women in England.

Conclusions: Older people who were less socially isolated were more likely to quit smoking in England than in Japan, possibly explained by the strict tobacco control policies in England.
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http://dx.doi.org/10.2188/jea.JE20200138DOI Listing
August 2020

Size of company of the longest-held job and mortality in older Japanese adults: A 6-year follow-up study from the Japan Gerontological Evaluation Study.

J Occup Health 2020 Jan;62(1):e12115

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

Objectives: Very few longitudinal studies have investigated the question of whether differences in company size may give rise to health inequalities. The aim of this study was to examine the relationship between company size of the longest-held job and mortality in older Japanese adults.

Methods: This study used longitudinal data from the Japan Gerontological Evaluation Study. Surveys were sent to functionally independent individuals aged 65 or older who were randomly sampled from 13 municipalities in Japan. Respondents were followed for a maximum of 6.6 years. The Cox proportional hazards model was used to calculate mortality hazard ratios (HRs) for men and for women. Analysis was carried out on 35 418 participants (197 514 person-years).

Results: A total of 3935 deaths occurred during the 6-year follow-up period. Among men, in Model 1 that adjusted for age, educational attainment, type of longest-held job, and municipalities, mortality HRs decreased significantly with increasing size of company (P for trend = .002). Compared to companies with 1-9 employees, the mortality HR (0.78, 95% confidence interval: 0.68-0.90) was significantly lower for companies with 10 000 or more employees. However, there were no significant differences among women (P for trend = .41).

Conclusions: In men, mortality in old age may decrease with increasing size of company of the longest-held job. To reduce health inequalities in old age due to differences in size of company, studies should be conducted to determine the underlying mechanisms and moderating factors and those findings should be reflected in labor policies and occupational health systems.
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http://dx.doi.org/10.1002/1348-9585.12115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176136PMC
January 2020

Association between childhood socioeconomic position and sports group participation among Japanese older adults: A cross-sectional study from the JAGES 2010 survey.

Prev Med Rep 2020 Jun 17;18:101065. Epub 2020 Feb 17.

Center for Preventive Medical Sciences, Chiba University, Japan.

Sports group participation may have greater effects on health outcomes than exercising alone. Unhealthy lifestyles were reported to be specifically associated with lower socioeconomic positions (SEPs), and child poverty and the bipolarization of sports participation are currently major policy concerns in children. However, it remains unclear whether childhood SEP has any long-latency effect on sports group participation among older Japanese. Data were obtained from the Japan Gerontological Evaluation Study 2010 project, which used self-report questionnaires to survey individuals aged ≥65 years without disability from 27 municipalities (n = 23,320). According to their answers, respondents were assigned to one of three SEP groups: high, middle, or low. Poisson regression with robust variance and multiple imputations was used to examine the association between childhood SEP and sports group participation. After adjusting for health-related factors, low childhood SEP was negatively associated with sports group participation in men (prevalence ratio [PR] = 0.82, 95% confidence interval [CI] = 0.74-0.91) and women (PR = 0.88, 95% CI = 0.80-0.97). The PR was greatly attenuated after adjusting for educational attainment in both men (PR = 0.92, 95% CI = 0.83-1.02) and women (PR = 0.98, 95% CI = 0.89-1.08), and the significant association disappeared. Low childhood SEP is thus associated with lower sports group participation among older Japanese, though this may be attenuated by education. These findings suggest that it may be necessary to consider childhood SEP and the importance of education to increase sports group participation at an older age.
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http://dx.doi.org/10.1016/j.pmedr.2020.101065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038007PMC
June 2020

Social Participation and Functional Decline: A Comparative Study of Rural and Urban Older People, Using Japan Gerontological Evaluation Study Longitudinal Data.

Int J Environ Res Public Health 2020 01 18;17(2). Epub 2020 Jan 18.

Department of Public Health, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8670, Japan.

This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.
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http://dx.doi.org/10.3390/ijerph17020617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013913PMC
January 2020

Neighborhood Ties Reduced Depressive Symptoms in Older Disaster Survivors: Iwanuma Study, a Natural Experiment.

Int J Environ Res Public Health 2020 01 3;17(1). Epub 2020 Jan 3.

Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi 980-8577, Japan.

: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. : Participants were 3567 individuals aged ≥65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. : Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward; their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (β = -0.39; 95% confidence interval: -0.72, -0.06). : Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.
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http://dx.doi.org/10.3390/ijerph17010337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981381PMC
January 2020

Assessment of Additional Medical Costs Among Older Adults in Japan With a History of Childhood Maltreatment.

JAMA Netw Open 2020 01 3;3(1):e1918681. Epub 2020 Jan 3.

Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Importance: Childhood maltreatment can have significant consequences on health through the life course, but its association with health care costs in later life is not widely known.

Objective: To assess whether a history of childhood maltreatment is associated with additional medical costs among older adults in Japan.

Design, Setting, And Participants: This population-based cross-sectional study used data from the Japan Gerontological Evaluation Study, 2013, linked with national health insurance claims data from April 2012 to March 2014 for 1 municipality that participated in the Japan Gerontological Evaluation Study, 2013. The municipality had more than 1.5 million residents, and 978 independent individuals aged 65 to 75 years were included in the analysis. Data were analyzed from October 2017 to February 2019.

Exposures: Childhood maltreatment, including physical abuse, emotional neglect, emotional abuse, and witnessing intimate partner violence.

Main Outcomes And Measures: Mean annual medical costs between April 2012 and March 2013 and between April 2013 and March 2014.

Results: Among 978 independent older adults (mean [SD] age, 70.6 [2.9] years; 426 [43.6%] men), 44 (4.5%) witnessed intimate partner violence, 19 (1.9%) were physically abused, 104 (10.6%) were emotionally neglected, and 56 (5.7%) were emotionally abused in childhood. In total, 176 older adults (18.0%) experienced at least 1 type of childhood maltreatment. Mean annual medical costs of those who experienced any childhood maltreatment were significantly higher than of those who did not (difference, ¥136 456 [US$1255]; 95% CI, ¥38 155-¥234 757 [US$351-US$2160]; P = .007). Those who experienced emotional neglect incurred more mean medical costs than those who did not (difference, ¥161 400 [US$1484]; 95% CI, ¥42 779-¥280 021 [US$394-US$2576]; P = .008). The association of any childhood maltreatment with medical costs remained significant after controlling for age and sex (average marginal effect, ¥116 098 [US$1068]; SE, ¥53 620 [US$493]; 95% CI, ¥11 004-¥221 192 [US$101-US$2034]; P = .03). The estimated additional costs associated with childhood maltreatment would be more than ¥333 billion (US$3.1 million) per year nationwide.

Conclusions And Relevance: In this study, childhood maltreatment was associated with additional medical costs among older adults living in Japan. This finding underlines the importance of primary and secondary prevention of child maltreatment.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.18681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991253PMC
January 2020

Specific types of sports and exercise group participation and socio-psychological health in older people.

J Sports Sci 2020 Feb 26;38(4):422-429. Epub 2019 Dec 26.

Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Older people who engage in sports and exercise in a group render greater benefits for socio-psychological aspects compared to exercising alone. The aim of this study was to identify the prevalence of specific types of sports and exercise groups and the association with self-rated health, depressive symptoms, and frequency of laughter among community-dwelling older people. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study and analysed 63,465 males and 68,497 females aged ≥65 years. The top three most popular types among males were golf (11.3%), walking (8.4%), and ground golf (6.3%). Among females, the top three were fitness exercises (13.8%), walking (8.3%), and weight exercises (6.2%). After adjusting for potential confounders, engaging in golf with a group was significantly related with excellent self-rated health (prevalence ratio, PR, 1.31 in male and 1.78 in female), low depressive symptoms (PR, 0.70 and 0.71), and a high frequency of laughter (PR, 1.12 and 1.13). Among females, walking displayed a significant relationship with all three characteristics (PR, 1.23, 0.79, and 1.06, respectively). Golf in older males and walking in older females might be the first choice for an effective programme to spread sports and exercise groups within the older Japanese community.
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http://dx.doi.org/10.1080/02640414.2019.1705541DOI Listing
February 2020

Pre-disaster social support is protective for onset of post-disaster depression: Prospective study from the Great East Japan Earthquake & Tsunami.

Sci Rep 2019 12 19;9(1):19427. Epub 2019 Dec 19.

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States of America.

We examined whether pre-disaster social support functions as a disaster preparedness resource to mitigate post-disaster depressive symptoms among older survivors of the 2011 Great East Japan earthquake and tsunami. The participants were 3,567 individuals aged ≥65 years living in Iwanuma city who completed a baseline survey as part of the nationwide Japan Gerontological Evaluation Study seven months before the disaster. A follow-up survey was administered approximately 2.5 years after the disaster. The analysis included a total of 2,293 participants, and social support (giving and receiving emotional & instrumental help) before the disaster was measured using four items. Depressive symptoms were assessed using the GDS with a cut-off score of 4/5 (not depressed/depressed). We discovered that participants who gave and received emotional and instrumental support before the disaster were significantly less likely to develop depressive symptoms after the disaster compared to those without support (ARR = 0.70; 95% CI: 0.56-0.88). The risk of the onset of depressive symptoms was 1.34 (95% CI: 1.03-1.74) among those who experienced disaster damages but had also given and received social support, and 1.70 (95% CI: 1.03-2.76) among those who experienced damages but lacked support. Strengthening social aid may help cultivate psychological resilience to disasters.
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http://dx.doi.org/10.1038/s41598-019-55953-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923367PMC
December 2019

Pre-disaster social support is protective for onset of post-disaster depression: Prospective study from the Great East Japan Earthquake & Tsunami.

Sci Rep 2019 12 19;9(1):19427. Epub 2019 Dec 19.

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States of America.

We examined whether pre-disaster social support functions as a disaster preparedness resource to mitigate post-disaster depressive symptoms among older survivors of the 2011 Great East Japan earthquake and tsunami. The participants were 3,567 individuals aged ≥65 years living in Iwanuma city who completed a baseline survey as part of the nationwide Japan Gerontological Evaluation Study seven months before the disaster. A follow-up survey was administered approximately 2.5 years after the disaster. The analysis included a total of 2,293 participants, and social support (giving and receiving emotional & instrumental help) before the disaster was measured using four items. Depressive symptoms were assessed using the GDS with a cut-off score of 4/5 (not depressed/depressed). We discovered that participants who gave and received emotional and instrumental support before the disaster were significantly less likely to develop depressive symptoms after the disaster compared to those without support (ARR = 0.70; 95% CI: 0.56-0.88). The risk of the onset of depressive symptoms was 1.34 (95% CI: 1.03-1.74) among those who experienced disaster damages but had also given and received social support, and 1.70 (95% CI: 1.03-2.76) among those who experienced damages but lacked support. Strengthening social aid may help cultivate psychological resilience to disasters.
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http://dx.doi.org/10.1038/s41598-019-55953-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923367PMC
December 2019

Neighborhood Walkability in Relation to Knee and Low Back Pain in Older People: A Multilevel Cross-Sectional Study from the JAGES.

Int J Environ Res Public Health 2019 11 20;16(23). Epub 2019 Nov 20.

Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.

Few studies have focused on a relationship between the built environment and musculoskeletal pain. This study aimed to investigate an association between neighborhood walkability and knee and low back pain in older people. Data were derived from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independently living people ≥65 years old. A cross-sectional multilevel analysis was performed, of 22,892 participants in 792 neighborhoods. Neighborhood walkability was assessed by residents' perceptions and population density. Dependent variables were knee and low back pain restricting daily activities within the past year. The prevalence of knee pain was 26.2% and of low back pain 29.3%. After adjusting for sociodemographic covariates, the prevalence ratio (PR) of knee and low back pain was significantly lower in neighborhoods with better access to parks and sidewalks, good access to fresh food stores, and higher population densities. After additionally adjusting for population density, easier walking in neighborhoods without slopes or stairs was significantly inversely correlated with knee pain (PR 0.91, 95% confidence interval 0.85-0.99). Neighborhoods with walkability enhanced by good access to parks and sidewalks and fresh food stores, easy walking without slopes or stairs, and high population densities, had lower prevalences of knee and low back pain among older people. Further studies should examine environmental determinants of pain.
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http://dx.doi.org/10.3390/ijerph16234598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926577PMC
November 2019

Elder Abuse and Social Capital in Older Adults: The Japan Gerontological Evaluation Study.

Gerontology 2020 12;66(2):149-159. Epub 2019 Sep 12.

Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Background: Elder abuse is a serious public health issue worldwide, but large-scale epidemiologic studies remain sparse. Although social factors in human relations such as social support and social isolation have been proposed as the factors related to elder abuse, cognitive social capital has not been examined.

Objective: This study aims to clarify the prevalence of and the factors associated with elder abuse among independent older adults in Japan.

Methods: The study design is a retrospective observational study. The data were derived from the Japan Gerontological Evaluation Study (JAGES). These self-report data were collected from 26,229 people aged 65 years or older living in 28 municipalities in 2013. The types of elder abuse and factors associated with them were examined using logistic regression analysis.

Results: The prevalence of elder abuse among the sample was 12.3% (11.1% in males and 13.3 in females). In the entire sample, physical, psychological, and financial abuses were reported to be 1.26, 11.12, and 1.45%, respectively. Factors associated with increased odds of experiencing abuse were being a woman, living with family members, having poor self-rated health, and having mild or severe depression. By contrast, age ≥85 years, being widowed, or unmarried, and having a positive view of community trust were associated with a lower risk of experiencing abuse.

Conclusion: While particular demographic factors and health are associated with a greater risk of elder abuse, our findings that trust within the community lessens the risk indicates the importance of social capital. This should be taken into consideration when developing population-based strategies to prevent elder abuse.
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http://dx.doi.org/10.1159/000502544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114897PMC
September 2020

Socio-economic status and dementia onset among older Japanese: A 6-year prospective cohort study from the Japan Gerontological Evaluation Study.

Int J Geriatr Psychiatry 2019 11 26;34(11):1642-1650. Epub 2019 Jul 26.

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

Objectives: Lower socio-economic status (SES) may be associated with dementia later in life, but there is inconsistent evidence supporting this claim. We aim to examine the association between three SESs (education, job, and income indicators) and dementia onset in older adults.

Methods: Study design was a 6-year prospective cohort study. Participants included a total of 52 063 community-dwelling adults aged 65 years or older without long-term care needs from the Japan Gerontological Evaluation Study. Outcome variable was dementia onset. Explanatory variables were educational years, the longest job held, and equivalised household income. We performed Cox proportional hazard analysis by gender with multiple imputation.

Results: During the follow-up period, 10.5% of participants acquired dementia. The adjusted risks of dementia incidence of the participants with less than 6 years of education were 1.34 times (95% confidence interval [CI], 1.04-1.73) in men and 1.21 (1.00-1.45) times in women higher than those with more than 13 years of education. Females with less than 1.99 million yen (hazard ratio = 0.83, 0.72-0.96) of equivalised income were less likely to acquire dementia than those with four million yen or higher.

Conclusions: Educational attainment had a robust impact on dementia onset compared with the other SES factors in both genders of older Japanese people. Securing an education for children could be crucial to prevent dementia later in life. The longest job held was less likely to be risks of dementia incidence, compared with the other two factors.
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http://dx.doi.org/10.1002/gps.5177DOI Listing
November 2019

Community-Level Sports Group Participation and the Risk of Cognitive Impairment.

Med Sci Sports Exerc 2019 11;51(11):2217-2223

Center for Preventive Medical Sciences, Chiba University, Chiba City, Chiba, JAPAN.

Purpose: Community-level group participation is a structural aspect of social capital that may have a contextual influence on individual health. We investigated the contextual effect of community-level prevalence of sports group participation on the risk of cognitive impairment among older individuals.

Methods: We analyzed prospective cohort data from the Japan Gerontological Evaluation Study, a nationwide survey of 40,308 functionally independent older individuals from 346 communities. Cognitive impairment was assessed by the nationally standardized dementia scale proposed by the Ministry of Health, Labour and Welfare of Japan. Participation in a sports group 1 d per month or more frequently was defined as "participation." We applied a two-level multilevel survival analysis to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results: The cumulative incidence of cognitive impairment during the 6-yr follow-up period was 9.8%. The mean proportion of sports group participation was 25.2% (range, 0.0%-56.5%). Higher prevalence of community-level sports group participation was associated with a lower risk of cognitive impairment (HR, 0.92; 95% CI, 0.86-0.99, estimated by 10 percentage points of participation proportion) after adjusting for individual-level sports group participation, sex, age, disease, obesity, social isolation, alcohol, smoking, education, income, depression, daily walking time, population density, and sunlight hours. We found cross-level interaction between individual- and community-level sports group participation (HR, 0.87; 95% CI, 0.76-0.99).

Conclusions: We found a contextual preventive effect of community-level sports group participation on developing cognitive impairment among older individuals. Furthermore, the benefit may favor sports group participants. Therefore, promoting sports groups in a community setting may be effective as a population-based strategy for the prevention of dementia.
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http://dx.doi.org/10.1249/MSS.0000000000002050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028475PMC
November 2019
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