Older Japanese People Research Articles

Clinical Phenotypes Associated with the Gut Microbiome in Older Japanese People with Care Needs in a Nursing Home

Background: Frailty increases the risk of needing nursing care and significantly affects the life and functional prognosis of older individuals. Early detection and tailored interventions are crucial for maintaining and enhancing their life functions. Recognizing distinct clinical phenotypes is essential for devising appropriate interventions. This study aimed to explore diverse frailty phenotypes, focusing on poor nutrition in older Japanese individuals through observational research. Methods: Twenty-one nursing home residents underwent a comprehensive survey covering physical, blood, dietary, cardiac, cognitive, nutritional, nursing care, frailty, agitated behavior, and gut microbiome assessments (high-throughput 16S rRNA gene sequencing). Using clustering analysis with 239 survey items (excluding gut microbiome), participants were classified into subgroups based on clinical phenotypes, and group characteristics were compared through analysis. Results: Individuals with moderate or severe frailty and suspected dementia formed subgroups with distinct clinical phenotypes based on nutritional, defecation, and nursing care statuses. The gut microbiome significantly varied among these groups (p = 0.007), indicating its correlation with changes in clinical phenotype. Nutritional status differences suggested poor nutrition as a differentiating factor in the core clinical phenotype. Conclusions: This study proposes that the gut microbiome differs based on the clinical phenotype of Japanese older individuals with frailty, and targeted interventions addressing the gut microbiome may contribute to preventing frailty in this population.

Relationship Between Swallowing Function and Low Serum Albumin Levels in Older Japanese People Aged ≥ 75 Years.

This cross-sectional study aimed to investigate the relationship between swallowing function and low serum albumin levels in older Japanese people (aged ≥ 75 years). A total of 3258 participants (1325 males, 1933 females; mean age, 80.8 years) who had a dental checkup in Gifu City, Japan, between April 2020 and March 2021 were recruited. Swallowing function was assessed using the repetitive saliva swallow test, with poor swallowing function defined as swallowing fewer than three times in 30 s. A serum albumin level < 3.6 G/dL was considered low. In total, 78 participants (2%) had a low serum albumin level. Furthermore, after adjusting for age, gender, circulatory disease, support/care-need certification, number of present teeth, and tongue and lip function, a low serum albumin level was positively associated with older (odds ratio [OR]: 1.115; 95% confidence interval [CI]: 1.064-1.169), male (OR: 2.208; 95% CI: 1.360-3.584), circulatory disease (OR: 1.829; 95% CI: 1.079-3.099), support/care-need certification (OR: 2.087; 95% CI: 1.208-3.606), and poor swallowing function (OR: 2.379; CI: 1.377-4.112). These results indicate that poor swallowing function was associated with a low serum albumin level in older Japanese people aged ≥ 75 years.

Impact of social isolation on change in brain volume in community-dwelling older Japanese people: The NEIGE Study

BackgroundSeveral studies have shown that social isolation is a risk factor for cognitive decline and dementia; however, its neurological mechanisms are not fully understood. Using longitudinal data, this study examined the effects of social isolation on hippocampal and total gray matter volumes in community-dwelling older Japanese individuals. MethodsData were obtained from the Neuron to Environmental Impact Across Generations (NEIGE) Study conducted in Tokamachi City (Niigata Prefecture, Japan), including 279 community-dwelling persons aged 65–84 years who underwent brain magnetic resonance imaging in 2017 and 2021 (male: 47.6 %; mean age: 73.0 years). We investigated two dimensions of social isolation: poor social networks and solitary living. ResultsMultiple regression analysis with inverse probability weighting showed that individuals with a social contact frequency of <1 time/week had a greater decrease in hippocampal volume than those with a contact frequency of more than or equal to 4 times/week, whereas those who lived alone tended to have a smaller decrease in hippocampal volume than those who lived with others. We found no association between the frequency of social contact, living alone, and total gray matter volume. Furthermore, there was no interaction between sex and age for any of the outcomes. ConclusionOur longitudinal analysis suggested that the relationship between social isolation and dementia onset may be mediated by hippocampal atrophy; however, the direction of the influence depends on the isolation type. These findings are expected to contribute to the elucidation of the social mechanisms underlying dementia onset.

Frailty and aging are associated with cognitive decline and dermal advanced glycation end-product accumulation in older Japanese men

BackgroundDermal advanced glycation end-product (AGE) accumulation is associated with various diseases, as well as frailty and aging. Frailty and aging are well known to be associated with a decline in cognitive function. We placed middle-aged and older Japanese people into four groups according to their physical frailty status and age, and then evaluated the relationship their dermal AGE accumulation and cognitive function. Materials and methodsWe performed a cross-sectional study of 559 participants (236 men, mean age 67.3 years). Dermal AGE accumulation in the forearms of the participants was assessed using skin autofluorescence (SAF), and cognitive function was assessed using the touch panel-type dementia assessment scale (TDAS). Parameters relating to anthropometry, atherosclerosis, and frailty were evaluated at medical check-ups. The factors independently associated with TDAS score were identified by multivariate analysis. ResultsMultivariate analysis showed that age and frailty were inversely associated with TDAS. We then allocated risk scores (0–3) to reflect the combination of these parameters (age, 0 or 1; SAF score, 0, 1, or 2). The SAF corresponding to a score of 2-3 points on the receiver operating characteristic curve was 2.18 units in men (sensitivity 67.2 %, specificity 70.0 %, area under the curve (AUC) 0.695, p < 0.001) and 2.03 units in women (sensitivity 65.8 %, specificity 52.3 %, and AUC 0.600, p = 0.009), implying a closer relationship in men than women. ConclusionsWe have identified a relationship between dermal AGE accumulation and a high risk of cognitive decline in middle-aged and older Japanese people, especially in men.

Summer Nutritional Status and Appetite Are Associated with the Frequency of Hot Meal/Drink Intake among Japanese Older People

Summer Nutritional Status and Appetite Are Associated with the Frequency of Hot Meal/Drink Intake among Japanese Older People

Predictive Factors Associated with Future Decline in Swallowing Function among Japanese Older People Aged ≥ 75 Years.

Predictive factors associated with a decline in swallowing function after 2 years were examined in 3409 Japanese older people aged ≥ 75 years who had undergone a dental checkup in Gifu Prefecture, Japan. Participants with normal swallowing function in a baseline survey in April 2018 were followed for 2 years. Swallowing function was assessed using a repetitive saliva swallowing test. In our study, 429 participants (13%) who were swallowing less than three times in 30 s based on a repetitive saliva swallowing test after 2 years were diagnosed as those with decline in swallowing function. Multivariate logistic regression analyses showed the decline in swallowing function after 2 years was associated with the male gender (odds ratio [ORs]: 0.772; 95% confidence interval [CIs]: 0.615-0.969), age ≥ 81 years (presence; ORs: 1.523; 95% CIs: 1.224-1.895), support/care-need certification (presence; ORs: 1.815; 95% CIs: 1.361-2.394), periodontal pocket depth (PPD) ≥ 4 mm (presence; ORs: 1.469; 95% CIs: 1.163-1.856), difficulty in biting hard food (yes; ORs: 1.439; 95% CIs: 1.145-1.808), choking on tea and water (yes; ORs: 2.543; 95% CIs: 2.025-3.193), and dry mouth (yes; ORs: 1.316; 95% CIs: 1.052-1.646) at baseline. Therefore, the dental checkup items associated with a decline in swallowing function after 2 years were a PPD ≥ 4 mm, difficulty in biting hard food, choking on tea and water, and dry mouth. PPD status and confirming to the self-administered questionnaire about biting, choking, and dry mouth may be useful in predicting future decline in swallowing function.

Determining the most appropriate socioeconomic status indicator for describing inequalities in dental visits by Japanese older people.

This study examined the association between various socioeconomic status (SES) indicators and dental visits among older Japanese. When examining health inequalities, an adequate indicator of SES should be applied. In older adults, wealth and pensions are considered more appropriate indicators of SES than education and income, but few studies have examined. This cross-sectional study used data from 12 391 individuals aged 65 years or older from the 2016 Japan Gerontological Evaluation Study (JAGES). The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were applied to examine the association of education, income, wealth and pensions with dental visits for treatment and check-up adjusting for covariates. The mean age of the participants was 74.0 ± 6.2 years. In the previous year, 56.3% of participants had visited a dentist for a check-up, and 65.9% had visited for treatment. Inequalities in dental treatment visits were observed for wealth, pensions and income rather than education. Income was not significantly associated with check-up visits. Wealth showed the largest association with dental visits for treatment [(SII 0.09, 95% CI 0.06 to 0.13), (RII 1.14, 95% CI 1.09 to 1.21)] and check-up [(SII 0.08, 95% CI 0.05 to 0.12), (RII 1.16, 95% CI 1.09 to 1.23)]. When measuring inequalities in access to dental care among the older population, wealth and pensions could be important indicators of SES.

Association between education and disability-free life expectancy among Japanese older people: The Ohsaki Cohort 2006 study

BackgroundHigher education level is associated with longer disability-free life expectancy (DFLE). However, evidence is scarce regarding factors that can contribute to eliminating inequality in DFLE according to education level. This study aimed to clarify the association between education and DFLE and estimate whether DFLE in people with lower education may increase to the same level as that in people with higher education through social participation. MethodsWe analyzed data from 13,849 Japanese people aged 65 years and older who participated in a 13-year prospective study. At baseline, we collected information on education levels (low, middle, or high) and social participation. DFLE was defined as the average duration people expect to live without disability. To calculate DFLE for each education level group, the multistate life table method was employed using a Markov model. ResultsAt the age of 65 years, DFLE (95 % confidence interval [CI]) in women with low education was 21.3 years (20.8–21.8) without social participation and 24.3 (23.8–24.9) with social participation. In the middle education group, DFLE was 22.1 (21.6–22.6) without social participation and 25.0 (24.6–25.5) with social participation. In the high education group, DFLE was 22.1 (21.5–22.8) without social participation and 25.5 (25.0–26.0) with social participation. Similar results were found for men. ConclusionsDFLE in people with low or middle education with social participation was almost the same as that in those with high education with social participation, suggesting the possibility that disparities in DFLE by education level could be offset by promoting social participation in older adults.

Association of Habitual Green Tea Consumption with Sarcopenia Assessed Using SARC-F in Community-Dwelling Japanese Older People: A Cross-Sectional Study.

To ascertain whether habitual green tea consumption is associated with sarcopenia among Japanese older adults, using the screening tool for sarcopenia (SARC-F). This cross-sectional study in Mukawa, Hokkaido, Japan, was conducted between June and September 2022 and included 364 Japanese participants older than 65 y. Habitual green tea consumption and energy intake were ascertained using a validated self-administered food frequency questionnaire. Sarcopenia was evaluated using the SARC-F. Multivariable logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of sarcopenia risk across participant tertiles of green tea consumption, with adjustments for age, sex, body mass index, living alone, habitual exercise, walking hours, current smoking status, current alcohol consumption status, energy intake, protein intake, vegetable intake, and fruit intake. In this study of 364 participants (154 men and 210 women), the prevalence of sarcopenia risk was 9.3%. The multivariable-adjusted OR [95% CI] of green tea consumption for ≥1 cup/d compared with that of <1 cup/wk of sarcopenia was 0.312 [0.129-0.752]. Higher habitual green tea consumption was inversely associated with sarcopenia among Japanese older adults. Further longitudinal studies are required to confirm these findings.

Are higher protein intake and distribution of protein intake related to higher appendicular muscle mass among an older Japanese population?: A cross-sectional analysis of the National Health and Nutrition Survey 2017.

Protein intake is an important component in retaining muscle mass, especially among older people. This study examined the relationship between total protein intake and/or the distribution of protein intake in each meal and appendicular muscle mass, using data from the National Health and Nutrition Survey (NHNS) in Japan. Data from the NHNS were re-analyzed in this study. We used data from a one-day dietary record, physical examination, and lifestyle questionnaire completed by 1766 participants aged over 60 years. Appendicular muscle mass was assessed by multiple-frequency bioimpedance measurement. Leucine intake was calculated by the weighted average amino acid content from all 98 food subcategories used in the NHNS, based on amino acid composition data in the 2020 Standard Tables of Food Composition. Participants with higher protein intake showed significantly higher appendicular muscle mass. This relationship was independent of physical activity, including steps taken per day, exercise habit, and physical labor. Frequent intake of ≥0.4 g protein/kg/meal was not related to appendicular muscle mass. The combination of higher total protein intake and higher physical activity seemed to have the largest association with appendicular muscle mass. Higher protein intake may be related to higher appendicular muscle mass, independent of higher physical activity, among older Japanese people. Geriatr Gerontol Int 2024; 24: 634-640.

Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis.

This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people. The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence. The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]). Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.

Association between oxidative balance score and inflammatory markers in middle-aged and older Japanese people.

This study aimed to investigate the association between oxidative balance score (OBS), wherein higher OBSs indicate lower oxidative stress, and high-sensitivity C-reactive protein (hs-CRP), as well as inflammatory scores, in a large cohort of Japanese adults. In total, 9703 individuals aged 40-69 years participated in a baseline survey of a population-based cohort study in Saga, Japan (2005-2007). OBSs were calculated from 11 prooxidant and antioxidant lifestyle factors, including dietary intake, physical activity, alcohol consumption, and smoking status. Lifestyle data, including dietary intake, were obtained using a self-administered questionnaire. Adjusted geometric means of serum hs-CRP levels were calculated based on OBS quartiles, and linear trend tests were performed, with adjustments for potential confounders. In addition, an inflammatory cytokine z-score was constructed and assessed alongside individual markers. After adjusting for multiple confounders in both sexes, the results showed a significant inverse association between OBS and serum hs-CRP levels in both men and women. These results remained unaltered when the OBS evaluation excluded powerful prooxidants, serum ferritin, or smoking. There was also an association between OBS and lower inflammatory z-score, indicating reduced overall systemic inflammation. These findings suggest that a higher OBS, indicating a greater predominance of antioxidants over prooxidant exposure, is associated with lower hs-CRP levels and reduced systemic inflammation, regardless of sex.

Does the neighborhood built and social environment reduce long-term care costs for Japanese older people? The JAGES2010-2019 cohort study

Japan's population has been aging steadily, evidenced by it spending JPY 11 trillion (USD 110 billion) on annual long-term care (LTC) costs in 2021. In this context, understanding the factors influencing LTC costs has become increasingly vital. Although studies have reported positive relationships between neighborhood environment and health outcomes, the connection between LTC costs and neighborhood environment remains unclear. To address this gap in the literature, this cohort study, conducted from 2010 to 2019 across seven Japanese municipalities and involving 34,982 older people, examined the relationship between eight neighborhood environment elements and the mean monthly cumulate costs (MMCC) of LTC. The results showed that older people who reported the presence of fresh food stores nearby and dangerous places for walking alone at night in the neighborhood had lower MMCC, by JPY 1,367.6 and 1,383.3 per month, respectively, than respondents who did not report the presence of these neighborhood elements. Meanwhile, older people whose neighborhoods had easily accessible facilities had higher MMCC of JPY 739.4. This study's key findings reveal significant relationships between neighborhood environment elements and LTC costs and can be used to support developments in urban design to support healthy aging and reduced LTC costs.

Self-Reported Oral Diseases and Their Association with the Frailty index among Older Japanese People: Four-Year Follow-Up.

Oral health is a relevant component for overall health. Oral disease onset at an early age and may harm several health dimensions, especially among older people, and has been associated with frailty. To evaluate associations between the Frailty Index (FI) and self-reported oral diseases among older, community-dwelling Japanese people. Cross-sectional and prospective analyses were performed. We analyzed data from 2,529 participants at the baseline and four-year follow-up of the Nihon University Japanese Longitudinal Study of Aging, which had a four-year follow-up. We used the self-reported number of teeth, self-reported satisfaction with dentures, and self-reported ability to chew hard food as independent variables. We computed an FI that included 40 deficits as the dependent variable. The FI score ranged from 0 to 1, with a higher score associated with adverse health outcomes and mortality. Considering a gamma distribution and controlling for age, gender, marital status, education, working status, and residence area, we fitted generalized linear models. We found that dissatisfied denture users had a 2.1% (95% CI 1.006-3.279) higher frailty score than non-denture users at the baseline and a 2.1% (95% CI 0.629-3.690) higher frailty score than non-denture users at the four-year follow-up. In the cross-sectional analysis, with each additional reported tooth at the baseline, the FI score was lower by 1.5% (95% CI -2.878 to -0.208) at the four-year follow-up. In both the cross-sectional and the prospective analyses, the FI scores increased as the ability to chew hard food decreased. Self-reported oral diseases are associated with the FI score cross-sectionally and prospectively. Identifying factors prospectively associated with frailty may improve strategies for the next generation of older people. Considering oral diseases may help clinicians personalize treatment plans for older people.

HOW ELDERLY PEOPLE INTERACT AFTER THEIR RETIREMENT WITH THE COVID-19 ERA IN JAPAN

Abstract Amid the COVID-19 pandemic, little is still known about how older Japanese people socialize after retirement. This paper aims to describe the dynamics of social interactions in post-retirement older adults during the COVID-19 pandemic. From January to March 2021, we interviewed 17 Japanese elderly people in Fukuoka and Ehime who were over 65 and have already retired. Face-to-face Interviews were conducted using a semi-structured questionnaire. After the initial transcripts were translated from Japanese to English, we checked the transcripts for accuracy and coded for analysis. The participant’s mean age was 71 years old while their retirement’s mean age was 60 years old. Only one participant had full retirement while the rest were partial retired which they continued to work as part-time workers either with new employers or with the same employers. All participants reported that their social interaction became estranged after retirement, and disrupted during the COVID-19 pandemic. However, participants communicated online and/or interacted face-to-face with (1) neighboring people as a member of community association or volunteers, (2) ex-work colleagues, (3) old schoolmate, (4) their children and/or grand-children, (5) friends with the same hobbies. Following factors that may affect the interactive behavior of Japanese older people were identified; (1) Japan’s healthcare policy and pension system, (2) individual’s socio-economic status, (3) family structure and living arrangement, (4) community’s characteristics, (5) individual’s psychological, cognitive and health status, and (7) individual’s personality. Comparisons of social interactions between Japanese and US older adults will be important to find new knowledge for preventing social isolation.

Effects of cigarette smoking and secondhand smoke exposure on physical frailty development among community-dwelling older adults in Japan: Evidence from a 10-year population-based cohort study.

This study explored longitudinally the relationship between smoking and secondhand smoke and the incidence of physical frailty in community-dwelling Japanese older people. Data collected from the National Institute for Longevity Sciences-Longitudinal Study of Aging database from 2002 to 2012 (third to seventh wave) among older adults aged ≥65 years were analyzed. Participants with physical frailty at baseline, as determined by the Cardiovascular Health Study criteria, missing data or who failed to attend follow ups were excluded. Data on current cigarette smoking and secondhand smoke exposure were collected from the third wave results. The generalized estimating equation model was used to examine the longitudinal relationships between smoking, secondhand smoke and subsequent frailty. The final analysis included 540 participants with a mean age of 71.4 years (standard deviation 4.6). The generalized estimating equation analysis showed that, compared with non-smokers, smokers were at significant risk of physical frailty (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.21-4.74) after adjustment for multiple covariates; especially men (OR 3.75, 95% CI 1.76-8.00) and older adults aged ≥75 years (OR 4.12, 95% CI 1.43-11.87). Participants exposed to both smoking and secondhand smoke had a higher risk of physical frailty (OR 3.47, 95% CI 1.56-7.73) than non-smokers without secondhand smoke exposure. Smokers exposed to secondhand smoke were associated with more risk of physical frailty (OR 9.03, 95% CI 2.42-33.77) compared with smokers without secondhand smoke exposure. Smoking, especially when combined with secondhand smoke exposure, is associated with future physical frailty among older adults. Geriatr Gerontol Int 2024; 24: 142-149.

Classification of community-dwelling older people based on their physical, mental, cognitive, and oral functions and comorbidities and its relationship with the fall history

To prevent falls among older adults, healthcare professionals need to assess these individuals from multiple perspectives. This study aimed to group community-dwelling older Japanese people based on their physical, mental, cognitive, and oral functions and comorbidities, and compare the history of falling in these groups. Data were obtained from a cross-sectional survey conducted in 2015 among older residents of a ward of Tokyo. For the survey, a questionnaire was distributed to all residents aged ≥65 years without a certificate of long-term care (n = 132,005). Questions were posed concerning respondents' physical, mental, cognitive, and oral functions; comorbidities; and experience with falling in the past year. Cluster and logistic regression analyses were performed. A total of 70,746 participants (53.4%) were included in the analysis. The mean age was 73.6 years old, and 44.9% were male. Four groups were identified in the cluster analysis: the "good general condition group" (n = 37,797, 52.4%), "poor mental function group" (n = 10,736, 14.7%), "moderate physical function group" (n = 13,461, 19.0%), and "poor general condition group" (n = 9,122, 12.9%). A logistic regression analysis with adjusting for socio-demographic characteristics, health behaviors, and fear of falling showed that the odds ratios for the experience of falling within the past year were 1.44 (95% confidence interval: 1.34-1.53), 1.54 (1.44-1.65), and 2.52 (2.34-2.71) in the poor mental function, moderate physical function, and poor general condition groups, respectively, with the good general condition group as the reference. We classified community-dwelling older adults into four groups based on multiple functions and found possible variations in the risk of falling by group. These findings suggest that such classification may be useful for the prevention of falls.

Alcohol consumption, smoking, and risk of dementia in community-dwelling Japanese people aged 40-74years: The Murakami cohort study.

Alcohol drinking and tobacco smoking have impacts on lifestyle-related diseases, but their association with dementia remains a debated topic. This study aimed to examine longitudinal associations between alcohol consumption, smoking, and dementia risk in middle-aged and older Japanese people. This study used a cohort design with an 8-year follow-up. Participants were community-dwelling Japanese people (N=13,802) aged 40-74years. The baseline survey, including a self-administered questionnaire, was conducted in 2011-2013. Predictors were alcohol consumption and tobacco smoking. The outcome was incident dementia obtained from a long-term care insurance database. Covariates were demographics, lifestyle factors, body mass index, general health status, and history of stroke, diabetes, and depression. Participant mean age was 59.0years. The 1-149, 150-299, and 300-449g ethanol/week groups had significantly lower adjusted hazard ratios (HRs) (0.62, 0.59, and 0.47, respectively) compared with the reference group, with no significant linear association. HRs increased toward 1 when past-drinkers and those with poor health status and a disease history were excluded (0.80, 0.66, and 0.82, respectively). Higher smoking levels were dose-dependently associated with a higher HR (adjusted P for trend=0.0105), with the ≥20 cigarettes/day group having a significantly higher adjusted HR (1.80). Heavy drinkers (≥449g ethanol/week) with smoking habits, but not those without smoking habits, had higher dementia risk (P for interaction=0.0046). Light-to-moderate alcohol consumption is associated with decreased dementia risk, and smoking is dose-dependently associated with increased dementia risk, with an interaction between high alcohol consumption and smoking on dementia risk.

The Relationship Between Cognitive Decline and All-Cause Mortality Is Modified by Living Alone and a Small Social Network: A Paradox of Isolation.

Although cognitive decline is a well-known mortality risk, it has not been adequately investigated, whether social relationships modify the relationship between cognitive decline and mortality. We examined the modifying effects of social relationships (household composition, social network [frequency of social contact with individuals outside the household], and social participation) on the association between cognitive decline and all-cause mortality in older Japanese people. In 2015, a baseline questionnaire was distributed to all 132,005 independent community-dwelling individuals aged ≥65 years resident in Adachi Ward of the Tokyo Metropolitan area. The final sample analyzed comprised 74,872 participants (men: 44.9%; mean age: 73.7 ± 6.0 years). Cognitive decline was assessed using a self-administered dementia checklist that was validated using the Clinical Dementia Rating Scale. A Cox proportional hazard model with an average follow-up of 1,657 days revealed that cognitive decline was associated with higher mortality (hazard ratio [HR]: 1.37, 95% confidence interval [95% CI]: 1.25-1.50). We identified significant associations among household composition, social networks, and cognitive decline. Stratified analyses indicated that the cognitive decline-mortality association was stronger among participants with low contact frequency (HR = 1.60, 95% CI: 1.39-1.85) than high frequency (HR = 1.24, 95% CI: 1.11-1.39). Conversely, the association was weaker among individuals living alone (HR = 1.13, 95% CI: 0.90-1.40) than among cohabiting individuals (HR = 1.43, 95% CI: 1.29-1.57). Although living alone and having a small social network represent an isolated status, their modifying effects were the opposite. These findings indicate that the isolation type should be considered when implementing support strategies for older adults with cognitive decline or dementia.

Association between adverse childhood experiences and marital status among Japanese older adults

BackgroundMarital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status. ObjectiveThis study examined the association between ACEs and marital status among older Japanese adults. Participants and settingThis research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan. MethodsACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression. ResultsThree or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13–1.76) and females (RRR, 95%CI = 1.56, 1.28–1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02–1.53) and females (RRR, 95%CI = 1.41, 1.18–1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66–2.90; in females: 3.45, 2.71–4.38; p for interaction = 0.034). ConclusionsACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.