Community-dwelling Older People In Japan Research Articles

Social participation among residents of serviced housing for older people versus community-dwelling older people in Japan: a propensity score matching analysis

Abstract Aim Housing has a significant impact on the health, safety, and social participation of older individuals. Japan’s Serviced Housing for Older People (SHOPs) is one such model that provides supportive services and accessible living spaces. Method This cross-sectional study examined the relationship between living in SHOPs with social activity programs (SAPs) and levels of social participation. We conducted a self-reported survey of SHOP residents and compared the proportions of participants who participated in social activities in the SHOP with a control group of community-dwelling older people selected from the Japan Gerontological Evaluation Study using propensity score matching. Results The survey obtained responses from 189 eligible participants. SHOP residents were primarily female, older, educated, unmarried, and had a better financial status than the control group. SHOP residents (n = 143) were 2.57 times more likely to exercise (p < 0.001), 1.62 times more likely to participate in hobbies (p = 0.004), and 4.37 times more likely to participate in learning activities (p < 0.001) than the control group (n = 398). However, volunteering, senior citizen clubs, neighborhood associations, and community gathering places participation did not differ significantly between the SHOP and control groups. Conclusion The findings suggest that SHOPs with SAPs have the potential to promote social participation and healthy aging among older people.

Types and frequency of social participation and comprehensive frailty among community-dwelling older people in Japan

Although research has established social participation as important for preventing frailty in older people, the association between the type and frequency of social participation and comprehensive frailty remains unclear. This study aimed to reveal the associations between types and frequency of social participation and comprehensive frailty among community-dwelling older people. This was a cross-sectional study conducted in four cities and towns (Inabe City, Nabari City, Odai Town, and Kiho Town) of Mie Prefecture, Japan, among adults who were: (i) aged ≥65 years and (ii) not certified as needing long-term care. We measured comprehensive frailty using the participants’ total scores on the Kihon Checklist, developed by Ministry of Health, Labour and Welfare of Japan, which divides frailty status into three categories: robust (0–3 points), prefrail (4–7), and frail (8–25). Types and frequency of social participation were explanatory variables, and ordered logistic regression analysis adjusted for potential confounding factors identified the associations. The frailty status of the 296 participants (age 65–74 years: 44.3 %; female: 74.0 %) was as follows: frail, 21.3 %; prefrail, 40.2 %; and robust, 38.5 %. Lower level of frailty was associated with interaction using smartphones 2–3 times per month, participating in sports ≥4 times per week, participating in local improvement activities several times per year, and engaging in activities for children 2–4 times per month. Social participation among older adults at appropriate frequencies were associated with the lower level of comprehensive frailty. However, future longitudinal studies are needed using populations from more diverse countries or regions and from different cultures.

Influence of Age on Associations of Occlusal Status and Number of Present Teeth with Dementia in Community-Dwelling Older People in Japan: Cross-Sectional Study.

While occlusal status has been reported to be related to cognitive function, little is known about the influence of age on that relationship. The present study examined the associations of tooth loss and occlusal status with dementia in the older people, as well as the effects of age on those relationships. A total of 196 older participants (median age: 84 years) were enrolled. Occlusal status was assessed using functional tooth units (FTU), calculated based on the number of paired natural or artificial teeth. Logistic regression analysis was then performed using dementia as the objective variable, and FTU or number of teeth as explanatory variables. The results showed that higher FTU was associated with lower risk of dementia. Furthermore, when stratified by median age, the association was greater for those aged less than 84 years. On the other hand, there was no significant association of number of present teeth with dementia. These results suggest that the risk of dementia is lower for individuals with better occlusion and that occlusal factor may have a greater effect on dementia onset in younger older people. It is thus recommended that both occlusal function and age be incorporated as factors in programs developed for dementia prevention.

Association between Bone-Related Physiological Substances and Oral Function in Community-Dwelling Older People.

Background: Oral dysfunction is related to long-term cares including activities of daily living. The objective of this study was to determine the association between oral function and the bone-related physiological substances osteocalcin (OC) and insulin-like growth factor-1 (IGF-1). Methods: The study participants were 139 community-dwelling older people in Japan. Evaluation of oral dysfunction was based on subjective judgment by each participant. Blood analysis included OC, IGF-1, and albumin. Results: Univariate and multiple logistic analyses showed that IGF-1 was significantly associated with a “decline in masticatory function” (p = 0.0074 and p = 0.0308, respectively). Receiver operating characteristic curve analysis of IGF-1 levels revealed a threshold score of 108 ng/mL (p < 0.01) for discriminating a “decline in masticatory function”. Logistic regression analysis revealed that participants with an IGF-1 level ≤108 ng/mL had an odds ratio of 4.31 (p < 0.05) for a “decline in masticatory function”. No significant association was found between the OC level and oral dysfunction. Conclusions: These results suggest a possible relationship between lower serum IGF-1 levels and a decline in masticatory dysfunction in community-dwelling older people.

Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan

Background The aim of this study is to explore the prevalence and overlap of physical, cognitive, psychological, and social frailty and their negative-interrelationships.Methods We conducted a survey of people aged ≥75 years in the region with the oldest population in Japan. Frailty was divided into physical, cognitive, psychological, and social frailty, which were evaluated with the Japanese version of the Cardiovascular Health Study (J-CHS) criteria, J-CHS and the Japanese version of the Montreal Cognitive Assessment, the Geriatric Depression Scale-15 and the Lubben Social Network Scale, respectively.Results Of the 268 participants (aged 81.5 ± 4.5 years), 48.1% and 8.6% had physical prefrailty and frailty; 68.3%, 13.0%, and 5.2% had mild cognitive impairment, dementia, and cognitive frailty; 25.7% and 5.2% had depressive mood and depression as psychological frailty; and 7.8% had social frailty, respectively. Path analysis showed that social frailty was associated with psychological frailty. Psychological frailty was associated with physical frailty. Physical frailty was associated with cognitive frailty. Multiple logistic regression analysis showed that independent determinants of physical robustness were female sex, age, and psychological robustness (odds ratio (OR) = 2.166, 0.831, 3.625, respectively). Determinants of cognitive robustness were age and psychological robustness (OR = 0.837, 7.079). Determinants of psychological robustness were physical, cognitive, and social robustness (OR = 3.759, 6.829, 5.037), and the determinant of social robustness was psychological robustness (OR = 4.489), respectively.Conclusions We demonstrated the prevalence, overlap, and interrelationships of different types of frailty and clarified the factors that may help to reduce frailty.

Diet and root surface caries in a cohort of older Japanese.

Root surface caries experience tends to increase with age. The purpose of this longitudinal study was to evaluate the relationship between aspects of dietary intake, including milk and sucrose in coffee or tea (SCT), and root surface caries in older Japanese individuals. 303 community-dwelling older individuals (age 75years) were enrolled for analysis. All participants underwent a dental examination at baseline and then annually from 2003 to 2008 (ie six times over a 5-year period). A disease event was considered to have occurred when root surface caries was detected on a previously sound or nonexposed root surface. Over the observation period, disease events in each year were counted. Dietary habits during the preceding month were evaluated using a brief self-administered diet history questionnaire (BDHQ) in 2003 and 2008. Poisson regression analysis performed crude and adjusted increment-rate ratios (IRRs) for root surface caries and the intake of milk and SCT. The adjusted increment-rate ratio (IRR) of the increment of root surface caries for participants in the highest SCT tertile was 1.72 (95%CI: 1.40-2.14) compared with the referent group. In addition, for the amount of milk intake, the adjusted IRR in the highest tertile was 0.63 (95% CI: 0.51-0.78) compared with the referent group. Much SCT and low milk intake were associated with the increment of root surface caries in community-dwelling older people in Japan. These findings suggest that to help prevent root surface caries, community-dwelling older people in Japan should consume adequate amounts of milk daily and limit their intake of SCT.

The low carriage prevalence of pneumococcus among community-dwelling older people: A cross-sectional study in Japan

BackgroundThe carriage prevalence of pneumococcus among community-dwelling older adults is not fully understood, especially in superaged societies. Our purpose was to elucidate the carriage prevalence of pneumococcus in the upper respiratory tract among Japanese community-dwelling adults aged ≥65 years. MethodsWe conducted a cross-sectional study of generally healthy community-dwelling adults aged ≥65 years in Nagasaki city, Japan. Demographic and clinical data and nasopharyngeal, oropharyngeal and saliva samples were collected from February 21st, 2018, to December 17th, 2018. The specimens were tested by culture and molecular methods. ResultsAmong a total of 504 enrolled participants, none were positive for pneumococcus by culture, and 22 were positive by PCR. The overall carriage prevalence was 4.4% (95% CI: 2.8–6.5%). The prevalence was highest in saliva samples, followed by oropharyngeal and nasopharyngeal samples. No demographic characteristics were associated with carriage prevalence, including age (4.7% among participants aged 65–74 years and 4.1% among those 75 years and older). Among the pneumococcal-positive participants, 18.2% were PCV13-covered serotypes. ConclusionsOur data suggest a low carriage prevalence of S. pneumoniae among community-dwelling older people in Japan.

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

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

Lifetime use of complementary and alternative medicine therapies among community-dwelling older people in Japan.

[Purpose] Three complementary and alternative medicine (CAM) therapies: “Judo therapy”, “acupuncture and moxibustion”, and “Japanese traditional massage and finger pressure” have been partially covered by the national health insurance in Japan. The lifetime prevalence of the use of these CAM therapies is not well known. The aim of the present study was to report the prevalence of the lifetime use of these CAM therapies. [Participants and Methods] We conducted a mailed self-administered questionnaire survey among community-dwelling older people in Japan in 2015. They were asked whether they had undergone any treatments with the 3 CAM therapies. The answers obtained were classified into 3 categories: current, ever, or never. We defined lifetime prevalence as the proportion of individuals who are currently using or have ever used any of these 3 therapies in the population. [Results] Overall, we approached 1051 individuals and 983 agreed to participate. Lifetime prevalence of Judo therapy, acupuncture and moxibustion, and Japanese traditional massage and finger pressure use was 28.0%, 17.8% and 15.8%, respectively, among males, and 44.5%, 18.4%, and 27.3%, respectively, among females. [Conclusion] These results showed that not only Western medicine but also CAM therapies are common among older people in Japan.

01 Prediction of Falls in Community-Dwelling Older People using an Accelerometer: The Results of a 1-Year Prospective Study

Abstract Background Fall preventive exercise for community-dwelling older people in Japan has a certain effect. The purpose of this study was to examine the predictors of fall risk in older people engaging in preventive exercise. Methods In this prospective study, we recruited 162 community-dwelling older people. We had them complete a self-report questionnaire containing items on weekly exercise frequency, exercise duration, exercise efficacy, amount of pain, number of diagnosis chronic diseases, health anxiety level, vision impairment, difficulty using the stairs, insomnia, fear of falling, history of falls, and forgetfulness, as well as the Falls Efficacy Scale. Walking speed and trunk acceleration during walking were also measured in all participants. From trunk acceleration, we calculated five gait parameters: fluctuation, weight shift, lateral balance, anteroposterior balance, and rhythm. Participants were classified as fallers or non-fallers according to the incidence of falls over a 1-year period from baseline assessment. Results Of all participants, 19 (11.7%) were classified as fallers and 143 (88.3%) as non-fallers. In comparing the fallers and non-fallers, we found significant differences in their exercise duration, exercise efficacy, amount of pain, history of falls, walking speed, and the gait parameters of weight shift and anteroposterior balance. A logistic regression analysis revealed that walking speed (odds ratio: 0.049, 95% confidence interval [CI]: 0.005-0.265, p=0.008) and weight shift (odds ratio: 0.021, 95%CI: 0.000-0.877, p=0.043) were predictors of falls. Conclusion The gait parameter of weight shift is the amplitude ratio of the auto-correlation function from vertical acceleration. This gait parameter is an original metrics and might show the temporal structure around the terminal stance. Measurement of gait parameters, in addition to physical performance, using an accelerometer seems beneficial for fall risk identification among community-dwelling older people engaged in fall preventive exercise.

EFFECTIVENESS OF A COMMUNITY HEALTH WORKER-BASED INTERVENTION TO IMPROVE DIETARY HABITS: A CROSSOVER TRIAL IN JAPAN

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

Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study.

Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown. This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality. We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates. Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76-0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69-0.91)]. Older individuals with a lower SES were less likely to recover from a pre-frailty status.

Actual conditions of dietary behavior among community-dwelling older people in Japan

Actual conditions of dietary behavior among community-dwelling older people in Japan

Associations of Skeletal Muscle Mass, Lower-Extremity Functioning, and Cognitive Impairment in Community-Dwelling Older People in Japan.

We examined whether skeletal muscle mass and lower extremity functioning are closely associated with multiple cognitive domains, including global cognition, memory, attention, executive functioning, and processing speed, in community-dwelling older Japanese adults. A cross-sectional, population-based community study. This study was conducted among community-living older people enrolled in the Obu Study of Health Promotion for the Elderly. Participants comprised 5,104 adults (≥ 65 years, mean age: 71 years). Data from 4273 participants were analyzed. Appendicular skeletal muscle mass was estimated from bioelectrical impedance analysis and expressed as appendicular skeletal muscle mass index (ASMI). Lower-extremity functioning was assessed by the Five-Times-Sit-to-Stand test (FTSS) and Timed Up and Go test (TUG). Cognitive functions were assessed by the Mini Mental State Examination, word list memory, Trail Making Test parts A and B, and Symbol Digit Substitution Task. Logistic regression analysis were performed to calculate odds ratios (ORs) of cognitive impairment in various domains among skeletal muscle mass, lower-extremity functioning levels adjusted for important demographic variables, and comorbidities. Participants with lower ASMI and slower FTSS and TUG groups had lower cognitive functioning scores than did participants with higher ASMI and faster FTSS and TUG. The slowest quartiles (Q4) of FTSS and TUG were significantly associated with impaired global functioning (MMSE score < 24) compared to the fastest quartile (Q1) after multivariate adjustment (FTSS, OR = 1.46, 95% confidence interval (CI) = 1.12-1.90; TUG, OR = 1.65, 95% CI = 1.25-2.17). In other dimensions of cognitive functioning, FTSS and TUG were significantly associated with all cognitive impairment in the full adjustment model. Lower-extremity functioning, rather than skeletal muscle mass, is closely related to multiple cognitive domains. This study suggests that maintaining lower-extremity functioning, rather than skeletal muscle mass, may be required for detecting and preventing cognitive impairment.

我が国における在宅高齢者への服薬支援の状況と課題に関する文献的検討

我が国における在宅高齢者への服薬支援の状況と課題に関する文献的検討

Laughter and Subjective Health Among Community-Dwelling Older People in Japan: Cross-Sectional Analysis of the Japan Gerontological Evaluation Study Cohort Data.

The aim of this study was to evaluate the association of laughter with subjective health independent of socioeconomic status and social participation among older people in Japan. We used the data of 26,368 individuals (men, 12,174; women, 14,194) 65 years or older who participated in the Japan Gerontological Evaluation Study (JAGES) in 2013. Participants provided information on laughter and self-rated health, depression, socioeconomic, and psychosocial factors. We evaluated laughter from three perspectives: frequency, opportunities, and interpersonal interactions. Even after adjustment for depression, sociodemographic factors, and social participation, the prevalence ratio for poor subjective health among women who never or almost never laugh was 1.78 (95% confidence interval, 1.48–2.15) compared with those who reported laughing every day. Similar associations were observed among men. Laughter may be an important factor for the promotion of general and mental health of older adults. The mechanisms linking laughter and health warrant further study.

Home visits by commissioned welfare volunteers and psychological distress: a population-based study of 11,312 community-dwelling older people in Japan.

Novel countermeasures to increase healthcare expenditures should be explored in rapidly aging societies, including Japan. Social support is a resource for the older people that effectively reduces psychological distress, with or without specialized health service provision. This cross-sectional study was conducted to determine whether home visits by commissioned welfare volunteers (organizations of community residents assigned by national or local governments) are associated with a lower risk of psychological distress among the older people. Questionnaires were sent in August 2010 to all residents aged ≥65 years in three municipalities (n = 21,232) in Okayama Prefecture in Japan; 13,929 were returned (response rate = 65.6%). The final sample size for the analysis was 11,312 participants. Home visits, psychological distress (Kessler Psychological Distress Scale: K6 > 5), and severe psychological distress (K6 > 13) were measured by the questionnaire. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for psychological distress, adjusting for age, gender, education, marital status, and qualification for long-term care insurance. The prevalence was 41.4% for psychological distress and 6.5% for severe psychological distress among all participants. Home visits were significantly associated with a lower risk of psychological distress after adjusting for the covariates (OR: 0.71, 95% CI: 0.65-0.77). These associations were comparable for men and women. The association was clearer for severe psychological distress (OR: 0.51, 95% CI: 0.43-0.61). Home visits by commissioned welfare volunteers are significantly associated with a lower risk of psychological distress among older people.

Factors associated with self-rated oral health among community-dwelling older Japanese: A cross-sectional study.

A cross-sectional study was carried out to investigate the determinants of self-rated oral health among community-dwelling older people in Japan. The participants were 897 (357 men and 540 women) aged 65 years and over who participated in a comprehensive geriatric health examination, which included an oral examination, a face-to-face interview assessing cognitive function, questionnaires regarding depressive symptoms and functional capacity, and a medical examination. The oral examination measured indices of oral health status: number of present teeth, number of functional teeth, occlusal force and amount of resting saliva. Multiple logistic regression analyses were carried out to determine the factors associated with poor self-rated oral health. The mean age of the participants was 73.5 ± 5.0 years. The prevalence of poor and rather poor self-rated oral health was 11.5% and 29.5%, respectively. Multiple logistic regression analyses showed that the number of present teeth (odds ratio [OR] 0.97, 95% confidence intervals [CI] 0.95-0.99), difficulty in mastication (OR 3.20, CI 2.18-4.70), presence of xerostomia (OR 1.43, CI 1.02-2.01), total score on the MoCA-J (OR 1.06, CI 1.01-1.11), and reduction in frequency of leaving the house (OR 1.64, CI 1.12-2.41) were significantly associated with poor self-rated oral health. The present results suggested that self-rated oral health was a significant factor in oral health status as well as overall well-being among community-dwelling older Japanese people.