Older Japanese People Research Articles

Oral self-care, pneumococcal vaccination, and pneumonia among Japanese older people, assessed with machine learning.

Pneumonia is a leading cause of death worldwide. It is a particularly serious burden in older people, as they tend to have a weakened immune response. Identifying the role of oral self-care and pneumococcal vaccination in healthy, independent older people can aid pneumonia prevention among them. This study investigated the associations between oral self-care, pneumococcal vaccination, and pneumonia experience among independent older people. This cross-sectional study used data from the 2016 Japan Gerontological Evaluation Study (JAGES). We used machine learning to examine the association between oral self-care and the experience of pneumonia over the previous year, stratified by pneumococcal vaccination. The covariates were sex, age, years of education, equivalent annual income, medical history of stroke, oral health status (choking, dryness, number of teeth), and smoking status. The analysis included 17,217 independent older people aged 65 and over. The prevalence of pneumonia experienced among those who brushed their teeth once or less per day was 4.5% and 5.3% for those with and those without pneumococcal vaccinations, respectively. In the unvaccinated group, the odds ratio of pneumonia experience for those who brushed their teeth once or less a day was 1.57 (95% CI 1.15-2.14) compared to those who brushed their teeth three or more times a day. By contrast, there was no significant association between the frequency of toothbrushing and the experience of pneumonia among people who received pneumococcal vaccination. Oral care influenced the experience of pneumonia among independent older people who did not receive pneumococcal vaccination.

Distinct associations between dietary omega-3 and omega-6 fatty acids intake with chronic kidney disease in adults with and without diabetes: A cross-sectional study

ObjectiveWe explored the relationship of dietary intake of fatty acids with chronic kidney disease (CKD) according to glycemic status in Japanese people. MethodsA total of 1031 participants aged ≥40 y were included in this population-based, cross-sectional study. A validated self-administered diet history questionnaire was used to measure the dietary intakes of fat and fatty acids, including omega-3 and omega-6 polyunsaturated fatty acids. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 and diabetes as the use of antidiabetic medication, fasting plasma glucose ≥ 126 mg/dL, or hemoglobin A1c of ≥6.5%. Urine biomarkers of kidney injury (liver-type fatty acid–binding protein, β2-microglobulin, and albumin) were also examined. ResultsThe mean age of the participants was 62.5 ± 11.2 y, and 482 (46.8%) of them were men. Overall, 177 (17.2%) participants had CKD. In the multivariable model, low omega-3 intake (odds ratio = 0.109; 95% CI, 0.019–0.645) and high omega-6–to–omega-3 ratio (odds ratio = 2.112; 95% CI, 1.167–3.822) were associated with CKD in participants with diabetes but not in those without. In selected participants with diabetes, a substantial trend of urinary liver-type fatty acid–binding protein and β2-microglobulin level elevation along with an increase in the dietary ratio of omega-6 to omega-3 was observed. ConclusionsLow dietary omega-3 intake and high omega-6–to–omega-3 ratio were associated with CKD in middle-aged and older Japanese people with diabetes but not in those without diabetes. These results may provide insight into the more tailored approaches for dietary polyunsaturated fatty acids to prevent CKD.

Association between social network and dietary variety among community-dwelling older adults.

Social networks are critical social health factors for older adults. This study examined the association between social networks and dietary variety among community-dwelling older adults. A cross-sectional study, using the dietary variety score (DVS) developed for older Japanese people to assess dietary variety and the Lubben Social Network Scale (LSNS-6) to assess social networks. N City, H Prefecture, Japan. Community-dwelling older adults aged ≥ 65 years (n = 1,229). The LSNS-6 score in the low DVS group was lower than that in the middle and high DVS groups (12.2 ± 5.6 vs. 13.4 ± 5.4 and 14.4 ± 5.7, P<0.001). The population of social isolation (LSNS-6, < 12) in the low DVS group was higher than that in the middle and high DVS groups (43.5% vs. 35.8% and 31.0%, P = 0.005). Multivariate linear regression analysis showed that the LSNS-6 score was positively correlated with DVS (standardized coefficient, 0.092; P = 0.002). Social isolation was also significantly associated with a low DVS in the multivariate-adjusted logistic analysis model (OR, 1.30; 95% CI, 1.00-1.68; P = 0.048). Stratified analysis results revealed the LSNS-6 and DVS were significantly associated in participants with the following characteristics: younger age (< 75 years), women, and those living with someone. Social networks were associated with dietary variety; social isolation was related to poor dietary variety among community-dwelling older adults. An association between social networks and dietary variety was observed among young-old older adults, women, and those living with someone.

Factors Influencing the Preferences of Older Japanese People for Long-term Care

As global aging increases, the issue of long-term care is becoming increasingly important. This study examined the factors influencing the preferences of older Japanese people for long-term care. Three hundred Japanese people over 65 years old were recruited to participate in this online survey on preferences for long-term care. Structural Equation Modeling (SEM) was conducted to demonstrate the effects of various variables. The results showed that support from the community, family savings, awareness of family caregiving, psychological indebtedness, and self-efficacy directly affected the preferences for long-term care. Gender, age, social participation, cohabitation, and health status self-assessment indirectly affected the preferences. This study demonstrated the influence of relevant factors, especially psychological factors, on the long-term care preferences of older Japanese people.

Statin persistence and adherence among older initiators: A nationwide cohort study using the national health insurance claims database in Japan.

This study clarifies the reality of persistence and adherence to statins in older Japanese people who initiated statin use and compares it between primary and secondary prevention cohorts. The nationwide study using the national claims database targeted statin initiators aged ≥55 years from FY2014 to FY2017 in Japan. Persistence and adherence to statins were analyzed overall and according to subgroups based on sex, age stratum, and prevention cohorts. Permissible gap of median days that statins were supplied per prescription to an individual was employed. Persistence rates were estimated as Kaplan-Meier estimates. Poor adherence during persistence was evaluated and defined as <0.8 of the proportion of days covered. Of 3 675 949 initiators, approximately 80% initiated statin use with strong variants. The persistence rate at 1 year was 0.61. Poor adherence to statins during persistence was 8.0% in all patients and this value gradually improved with increasing age. Persistence rate and adherence were lower for the primary prevention cohort than for the secondary prevention cohort, and a notable sex difference was observed for the secondary prevention cohort, which was lower in females but was almost never and slightly observed in the primary prevention cohorts without and with high-risk factors, respectively. Many statin initiators discontinued statins shortly following statin initiation but adherence while on statin therapy was good. Attentively watching older patients not to discontinue statins and listening to their reasons for discontinuation are required, especially for initiators in primary prevention and females in secondary prevention.

Associations of Cooking Skill with Social Relationships and Social Capital among Older Men and Women in Japan: Results from the JAGES.

The health benefits of social relationships and social capital are well known. However, little research has examined the determinants of social relationships and social capital. We examined whether cooking skill was associated with social relationships and social capital in older Japanese people. We used 2016 Japan Gerontological Evaluation Study data on a population-based sample of men and women aged ≥ 65 years (n = 21,061). Cooking skill was assessed using a scale with good validity. Social relationships were evaluated by assessing neighborhood ties, frequency and number of meetings with friends, and frequent meals with friends. Individual-level social capital was evaluated by assessing civic participation, social cohesion, and reciprocity. Among women, high-level cooking skill was positively associated with all components of social relationships and social capital. Women with high-level cooking skill were 2.27 times (95% CI: 1.77-2.91) more likely to have high levels of neighborhood ties and 1.65 (95% CI: 1.20-2.27) times more likely to eat with friends, compared with those with middle/low-level cooking skill. Cooking skills explained 26.2% of the gender difference in social relationships. Improving cooking skills may be key to boosting social relationships and social capital, which would prevent social isolation.

Relationship of Higher-level Functional Capacity With Long-term Mortality in Japanese Older People: NIPPON DATA90.

Basic and instrumental activities of daily living (BADL and IADL, respectively) are known predictors of mortality. However, the relationship between higher-level functional capacity (HLFC) and mortality and related sex differences have rarely been investigated. A prospective population-based cohort study was conducted in 1,824 older residents (≥65 years) with independent BADL from 300 randomly selected areas in Japan from 1995, and the participants were followed up until 2010. Using the Cox proportional hazards model, the relationship between HLFC and mortality risk was investigated, with adjustment for possible confounders. HLFC was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Baseline data were collected using a questionnaire or by home-visit interviews. During an average 12.2-year follow-up, all-cause death was observed in 836 (45.8%) participants. Impaired HLFC was significantly associated with mortality (hazard ratio [HR] 1.37; 95% confidence interval [CI], 1.13-1.65). Lower social role was significantly associated with higher mortality risk in men (HR 1.38; 95% CI, 1.13-1.68). Lower IADL and intellectual activity were significantly associated with higher mortality risk in women (HR 1.50; 95% CI, 1.15-1.95 and HR 1.46; 95% CI, 1.19-1.79, respectively). The relationship between HLFC and mortality risk showed a similar tendency among cardiovascular diseases, stroke, cancer, and pneumonia. Impaired HLFC was associated with a high risk of all-cause mortality among community-dwelling older people with independent BADL. In particular, social role in men and IADL and intellectual activity in women were associated with long-term mortality risk.

Pharmacokinetics of Bictegravir in Older Japanese People Living with HIV-1.

Bictegravir (BIC) is an integrase strand transfer inhibitor widely used in the treatment of HIV-1. Although its potency and safety have been demonstrated in older patients, pharmacokinetics (PK) data remain limited in this patient population. Ten male patients aged 50 years or older with suppressed HIV RNA on other antiretroviral regimens were switched to a single-tablet regimen of BIC, emtricitabine, and tenofovir alafenamide (BIC+FTC+TAF). Four weeks later, plasma samples were collected at 9 time points for PK. Safety and efficacy were also assessed up to 48 weeks. The median age (range) of patients was 57.5 (50 to 75) years. Although 8 (80%) had lifestyle diseases requiring treatment, no participants had renal or liver failure. Nine (90%) were receiving dolutegravir-containing antiretroviral regimens at entry. The trough concentration of BIC was 2,324 (1,438 to 3,756) (geometric mean [95% confidence interval]) ng/mL, which was markedly above the 95% inhibitory concentration of the drug (162 ng/mL). All PK parameters, including area under the blood concentration-time curve and clearance, were similar to those in young HIV-negative Japanese participants in a previous study. No correlations between age and any PK parameters were observed in our study population. No participant experienced virological failure. Body weight, transaminase, renal function, lipid profiles, and bone mineral density were unchanged. Interestingly, urinary albumin was decreased after switching. PK of BIC was not affected by age, indicating that BIC+FTC+TAF may be safely used in older patients. IMPORTANCE BIC is a potent integrase strand transfer inhibitor (INSTI), widely used for the treatment of HIV-1 as part of a once-daily single-tablet regimen that includes emtricitabine and tenofovir alafenamide (BIC+FTC+TAF). Although the safety and efficacy of BIC+FTC+TAF have been confirmed in older patients with HIV-1, PK data in this patient population remain limited. Dolutegravir (DTG), an antiretroviral medication with a similar structural formula to BIC, causes neuropsychiatric adverse events. PK data for DTG have shown a higher maximum concentration (Cmax) among older patients than younger patients and are related to a higher frequency of adverse events. In the present study, we prospectively collected BIC PK data from 10 older HIV-1-infected patients and showed that PK of BIC are not affected by age. Our results support the safe use of this treatment regimen among older patients with HIV-1.

A characteristic N-glycopeptide signature associated with diabetic cognitive impairment identified in a longitudinal cohort study

BackgroundIdentifying a biomarker for the decline in cognitive function in patients with diabetes is important. Therefore, we aimed to identify the N-glycopeptides on plasma proteins associated with diabetic cognitive impairment in participants in a longitudinal study using N-glycoproteomics. MethodsWe used samples from the 3-year SONIC (Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians) longitudinal cohort study of older Japanese people in the general population. First, we placed the participants with diabetes into two groups: those that did or did not have cognitive decline over a 6-year period. Next, their plasma protein profiles were compared between baseline and the 6-year time point using two-dimensional fluorescence difference gel electrophoresis. Finally, an N-glycoproteomic study of the focused proteins was performed using an enrichment technique and liquid chromatography-tandem mass spectrometry. ResultsApproximately 500 N-glycopeptides, derived from 18 proteins, were identified in each sample, from among which we identified the N-glycopeptides that were associated with diabetic cognitive impairment using multivariate analysis. We found that N-glycopeptides with sialylated tri- or tetra-antennary glycans on alpha-2-macroglobulin, clusterin, serum paraoxonase/arylesterase 1, and haptoglobin were less abundant, whereas 3-sialylated tri-antennary N-glycopeptides on serotransferrin were more abundant. ConclusionN-glycopeptides with sialylated multi-antennary glycans comprise a characteristic signature associated with diabetic cognitive impairment. General significanceThe characterized N-glycopeptides represent potential biomarker candidates for diabetic cognitive impairment.

Factors Influencing the Preferences for Informal Care among Older Japanese People—Using Psychological Factors

Factors Influencing the Preferences for Informal Care among Older Japanese People—Using Psychological Factors

PS-BPP06-7: ASSOCIATION BETWEEN SALT INTAKE AND BLOOD PRESSURE IN COMMUNITY-DWELLING OLDER PEOPLE: THE SONIC STUDY

Objective: It is well known that excessive salt intake is associated with hypertension (HT) and salt intake reduction lowers blood pressure. However, the knowledge of salt intake and blood pressure in the older people is not sufficient. This study aimed to clarify the relationship between salt intake and blood pressure among community-dwelling Japanese older people. Design and method: This study was cross-sectional design based on a prospective cohort study called the SONIC (Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians) study. We used data collected from 2010 to 2012. The dependent variable was the blood pressure at the venue and the independent variable was salt intake. Salt intake was calculated using the brief-type self-administered diet history questionnaire (BDHQ). After adjustment for energy using the residual method, Salt intake was classified into quartiles. Blood pressure values for each quartile were compared by Jonckheere-Terpstra test. Results: The number of participants was 2,163 (female: 53.3%). Persons who may have over- or under-reporting nutrition and had no blood pressure data was excluded. Participants of 70 ± 1 years old were 947 (HT: 50.2%), 80 ± 1 years old were 951 (HT: 63.9%), 90 ± 1 years old were 265 (HT: 50.6%). There was no clear difference of systolic blood pressure among the four quartiles of salt intake. Participants taking angiotensin II receptor blocker (ARB) were 448, and mean systolic blood pressure in the four quartiles of salt intake were Q1:142.1 ± 17.7mmHg, Q2: 145.2 ± 17.3, Q3: 146.1 ± 17.2, and Q4: 147.8 ± 18.8. There was a stepwise increase in systolic blood pressure with increasing salt intake quartile (p = 0.018 for trend). Conclusions: For the elderly taking ARBs, salt reduction was shown to improve blood pressure control, but for the other elderly, no effect of salt intake was observed. Further studies are needed to examine including other factors what affects blood pressure for older population.

Relationship between Oral Function and Support/Care-Need Certification in Japanese Older People Aged ≥ 75 Years: A Three-Year Cohort Study.

The aim was to examine the relationships between oral functions and support/care-need certification in older people aged ≥ 75 years using the National Health Insurance (NHI) database system and data from Kani City, Gifu, Japan. In total, 732 older Japanese people aged ≥ 75 years who did not have support/care-need certification and underwent dental check-ups in Kani City in 2017 were followed up until 2020. Chewing state, tongue and lip function, and swallowing function were assessed by a self-administered questionnaire, an oral diadochokinesis test, and a repetitive saliva-swallowing test, respectively. The presence or absence of systemic diseases and of support/care-need certification was based on data collected by the NHI database. At follow up, 121 (17%) participants had support/care-need certification. The participants with support/care-need certification included more women (p < 0.001) and older people (p < 0.001); and had more hypertension (p = 0.003), musculoskeletal disorders (p < 0.001), pneumonia (p = 0.044), poor chewing state (p < 0.001), and poor swallowing function (p = 0.003) than those without support/care-need certification. Furthermore, the presence of support/care-need certification at follow up was associated with sex (woman: odds ratio [OR], 2.120; 95% confidence interval [CI], 1.354 to 3.317), age (OR, 1.203; CI, 1.139 to 1.270), chewing state (poor: OR, 2.534; CI, 1.409 to 4.557), and swallowing function (poor: OR, 2.372; CI, 1.248 to 4.510) at baseline. However, tongue and lip function were not associated with support/care-need certification. The results indicate that older Japanese people aged ≥ 75 years with a poor chewing state and poor swallowing function at baseline had a higher risk for support/care-need certification after three years.

Dietary Problems Are Associated with Frailty Status in Older People with Fewer Teeth in Japan.

This study aimed to investigate the association between dietary problems and frailty according to tooth loss in older Japanese people. This cross-sectional study included 160 older people (mean age 82.6 years) from Japan. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria, which consists of (i) weight loss > 5% in the past year, (ii) inability to perform five chair stands, and (iii) self-perceived reduced energy level. Frailty was defined as the presence of ≥2 items of SOF criteria. Multivariate logistic regression analyses were performed with frailty as the dependent variable and dietary problems as the independent variable, stratified according to having <20 teeth. Low appetite and no enjoyment of eating were associated with frailty after adjusting for covariates in participants with <20 teeth. Dietary problems, including low appetite, eating alone, and negative attitudes toward enjoyment of eating were associated with a self-perceived reduced energy level in participants with <20 teeth. However, this association was not observed in participants with ≥20 teeth. In older people with fewer teeth, dietary problems have been suggested to be associated with frailty. Therefore, it may be necessary to pay attention to dietary problems, especially in older people with tooth loss.

Volunteer activity and the prevalence of long-term care/support needs among older Japanese people: a spatial error model

Background: Volunteer activities, one type of social participation, are important for preventing the need for long-term care/support. This study aimed to identify the associations between volunteer activities and prevalence of older people’s long-term care/support needs in Japan. Methods: This was a cross-sectional ecological study of data from 47 prefectures collected by Statistics Bureau of Japan. We performed model specification using ordinary least squares (OLS) and best subset selection to elucidate the associations between the prevalence of older people’s long-term care/support needs and their participation in volunteer activities for people aged ≥ 10 years. For spatially adjusted associations, we evaluated the variables using a spatial error model (SEM). Results: The mean prevalence of long-term care/support needs was higher for older female than male (male: 12.82%; female: 22.55%). Volunteer activities with the highest mean participation rates were local improvement activities (male: 15.20%; female: 11.94%) and activities for children (male: 6.74%; female: 10.45%). OLS and SEM indicated that safety promotion activities (OLS: B = −0.156, p = 0.010; SEM: B = −0.160, p = 0.049) and activities related to international cooperation (OLS: B = −1.086, p = 0.034; SEM: B = −1.041, p = 0.020) were associated with low prevalence of long-term care/support needs among male older people. In both models, conservation and environmental activities (OLS: B = −0.892, p = 0.019; SEM: B = −0.805, p = 0.015) and activities for children (OLS: B = −0.605, p = 0.003; SEM: B = −0.420, p=0.018) were associated with low prevalence for female older people. Conclusion: Volunteer activities in this study might effectively decrease the prevalence of long-term care/support needs among older people.

Pneumonia and subsequent risk of dementia: Evidence from the Japan Gerontological evaluation study.

Recently, several studies reported that pneumonia might increase the risk of cognitive decline and dementia due to increased frailty. This study aims to examine the association between a history of pneumonia and subsequent dementia risk. Participants were 9952 aged 65years or older Japanese men and women from the Japan Gerontological Evaluation Study prospective cohort study, followed up from 2013 to 2019. Dementia was identified by public long-term care insurance registration. A history of pneumonia contracted 1year before the baseline questionnaire in 2013. A cox regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia risk, adjusted for potential confounding variables. We conducted competing risk analyses using a cause-specific hazard model. During the follow-up period of 6years, 939 persons developed dementia. There was no association between having a prior history of pneumonia with dementia risk (HR 1.20, 95% CI:0.81-1.78). However, we observed an increased risk of dementia in persons with pre-frailty and frailty; the multivariable HR (95% CI) was 1.75 (1.48-2.07) and 2.42 (2.00-2.93) for pre-frailty and frailty, respectively. When pneumonia and frailty were combined, the risk of dementia was the highest for the persons with a history of pneumonia and frailty; the multivariable HR (95% CI) was 2.30 (1.47-3.62). The multivariable HR (95% CI) for those without pneumonia with frailty was 1.95 (1.66-2.28). Meanwhile, the multivariable HR (95% CI) for those with pneumonia without frailty was 1.64 (0.68-3.99). Our findings imply that a prior history of pre-frailty and frailty with or without pneumonia, but not a history of pneumonia per se, was associated with an increased risk of dementia among population-based-cohort of older Japanese people.

Self-reported hearing and vision impairment and incident frailty in Japanese older people: A 3-year longitudinal analysis of the Japan Gerontological Evaluation Study

BackgroundWe examined the associations and interactions of hearing impairment (HI) and vision impairment (VI) with frailty. MethodsWe performed a 3-year longitudinal analysis of the Japan Gerontological Evaluation Study (JAGES), a nationwide prospective cohort study of functionally independent Japanese older people (age ≥ 65 years). Frailty status at baseline and follow-up was defined according to the Kihon Checklist. HI and VI at baseline were self-reported. Logistic regression models were used to examine the main and interaction effects of HI and VI on incident frailty during a 3-year follow-up period. ResultsOf the 7,852 participants (mean age 73.2 years, standard deviation 5.6; 50.7% women), 9.7%, 5.3%, and 1.9% reported HI, VI, and concurrent HI and VI, respectively. After adjusting for possible confounders and the other sensory impairment, VI (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.62–3.85, p < 0.001), but not HI (OR 1.29, 95% CI 0.97–1.72, p = 0.081), was significantly associated with incident combined pre-frailty and frailty from a robust baseline. No interaction was observed between HI and VI (OR 0.83, 95% CI 0.38–1.81, p = 0.636). We observed no significant associations between sensory impairments and incident frailty from a pre-frail baseline (HI: OR 1.26, 95% CI 0.88–1.80, p = 0.205; VI: OR 1.44, 95% CI 0.90–2.31, p = 0.127; interaction between HI and VI: OR 1.16, 95% CI 0.53–2.53, p = 0.718). ConclusionsVI, rather than HI, may be an independent risk factor for frailty, without any interaction between the two.

Prevalence of medical factors related to aging among older car drivers: a multicenter, cross-sectional, descriptive study

AimAn increasing number of older adults in Japan are at an increased risk of road traffic crashes. This study aimed to investigate the prevalence of potential underlying medical factors that increase the risk of road traffic crashes among older people.MethodsThis cross-sectional observational study was conducted in 11 medical institutions in Japan using self-administered questionnaires and physical examination from January to May 2021. The background and social data, data on the use of nursing care insurance, and clinical data suggestive of polypharmacy, sarcopenia, cognitive impairment, and frailty/oral frailty were obtained. The prevalence of these factors was compared between everyday and occasional drivers.ResultsData of 127 patients were collected; their median (interquartile range) age was 73 (70–78) years. Of the total participants, 82 were men (64.6%) and 45 were women (35.4%). There were 77 everyday drivers and 50 occasional drivers. Of these, 121 (95.3%) had not applied for nursing care insurance, but the numbers of those who required help 1 and 2 were 1 (0.8%) and 3 (2.4%), respectively. Prevalence of medical factors was as follows: polypharmacy, 27.6%; sarcopenia, 8.7%; dementia, 16.4%; frailty, 15.0%; and oral frailty, 54.3%; it was not significantly different between every day and occasional drivers. Intention to return the car license was significantly higher among the occasional drivers (2.6% vs. 14.0%; odds ratio: 6.7, 95% confidence interval: 1.2–70.6, p = 0.024).ConclusionWe uncovered the prevalence of medical factors that can be associated with road traffic crashes among Japanese older people aged ≥ 65 years in our community.

Association Between Social Participation and Disability-free Life Expectancy in Japanese Older People: The Ohsaki Cohort 2006 Study.

BackgroundAlthough social participation has been reported to be associated with significantly lower risks of mortality and disability, to our knowledge, no study has estimated its impact on disability-free life expectancy (DFLE). Therefore, this study aimed to investigate the association between social participation and DFLE in community-dwelling older people.MethodsWe analyzed 11-year follow-up data from a cohort study of 11,982 Japanese older adults (age ≥65 years) in 2006. We collected information on the number of social participations using a questionnaire. Using this information, we categorized the participants into four groups. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was employed for calculating DFLE.ResultsThe results revealed that DFLE according to the number of social participations was 17.8 years (95% confidence interval [CI], 17.3–18.2) for no activities, 20.9 (95% CI, 20.4–21.5) for one activity, 21.5 (95% CI, 20.9–22.0) for two activities, and 22.7 (95% CI, 22.1–23.2) for three activities in men, and 21.8 (95% CI, 21.5–22.2), 25.1 (95% CI, 24.6–25.6), 25.3 (95% CI, 24.7–25.9), and 26.7 years (95% CI, 26.1–27.4), respectively, in women. This difference in DFLE did not change after the participants were stratified for smoking, body mass index, physical activity, and depression.ConclusionSocial participation is associated with longer DFLE among Japanese older people; therefore, encouraging social participation at the population level could increase life-years lived in good health.

Family social support and stability of preferences regarding place of death among older people: a 3-year longitudinal study from the Japan Gerontological Evaluation Study.

Backgroundit remains unclear how family relationships could affect stability of end-of-life care preferences.Objectiveto describe change patterns of preferred place of death (POD) among older people and to examine associations between family social support and stability of preferences regarding POD.Methodsthis longitudinal study of 1,200 noninstitutionalized independent Japanese older people aged over 65 years used panel data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Preference stability was defined as the congruence of preferred POD based on questionnaires between baseline and follow-up. We performed multiple logistic regression analysis and gender-stratified analysis to examine associations between social support (spouse, children living together and children living apart) and preference stability.Resultsonly 40.9% of participants had stable preferences. For a spouse, both receiving and providing social support was associated with less stable preferences (OR: 0.63, 95% CI: 0.43–0.93; OR: 0.55, 95% CI: 0.38–0.80, respectively), and providing social support to children living apart was associated with more stable preferences (OR: 1.35, 95% CI: 1.03–1.76). In gender-stratified analysis, significant associations between preference stability and providing social support to a spouse among women (OR: 0.53, 95% CI: 0.34–0.82) and providing social support to children living apart among men (OR: 1.72, 95% CI: 1.16–2.55) were observed.Conclusionsfamily social support was associated with the stability of preferences, and the associations differed by support resources and gender. Incorporating family members in the process of end-of-life care discussion may be necessary for establishing stable preferences.

Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study

ObjectivesClassifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although...