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Abstract
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.
Highlights
A strategy of active ageing [1], by linking the key policy domains of employment, pension, retirement, health, and citizenship, provides a sound basis to respond to the challenges presented by population ageing [2]
The distribution of participation in work differed between rural and urban areas (p < 0.001; Cramer’s V = 0.1); it was thought to be due to the missing category
This study showed that working support and improvement of working environment could be public health policies that would prevent the need for the provision of long-term care in rural and urban areas
Summary
We used longitudinal data from the Japan Gerontological Evaluation Study (JAGES). JAGES is one of the few population-based gerontological repeated surveys in Japan focused on the social determinants of health and the social environment [31,32]. From August 2010 to January 2012, self-reported questionnaires were mailed to 95,827 community-dwelling independent individuals aged 65 years and older who were not eligible to receive benefits from public long-term care insurance services. They were randomly selected from 13 municipalities, including rural and urban areas. 62,418 people participated (response rate, 65.1%) in the survey called JAGES2010. They were followed up for about six years (minimum 5.2 years; maximum 6.4 years). The final number of participants in this analysis was 47,306
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