Older People In Japan Research Articles

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.

Fragility Fractures in Older People in Japan Based on the National Health Insurance Claims Database

Fragility fractures associated with age-related bone loss are of urgent concern worldwide because they reduce QOL and pose financial burdens for health care services. Currently, national data in Japan are limited. This study provides quantitative data for older patients throughout Japan who, although otherwise relatively healthy, sustained fragility fractures and were hospitalized for them. The National Database of Health Insurance Claims and Specific Health Checkups of Japan was accessed to target patients aged 65 years or older who sustained fractures between May 2013 and September 2014 and were not hospitalized for at least 13 months prior to fracture. We investigated whether the first fracture sustained was fragility related at any of four locations (proximal humerus, distal radius, vertebra, or femoral neck) and whether it necessitated hospitalization. Fragility fractures were identified in 490138 of 1188754 patients (41.2%, 345980 patients/year; 1 : 4 male-to-female ratio). Regardless of gender, vertebral fractures were most common across the age cohorts studied (43286 males and 162767 females/year), and femoral neck fractures increased markedly with increased patient age. Approximately 80% of patients with femoral neck fractures were hospitalized (62.3% of males, 71.1% of females) compared with up to 10.4% of patients with other fragility fractures. Data provided in this study can be used as a baseline for evaluating the health economy and establishing health policy in Japan.

The Physical Housing Environment and Subjective Well-Being Among Older People Using Long-Term Care Services in Japan

For older people using long-term care services, the conditions of their life-space may be critical. The relationships between the physical housing environment and aspects of health were examined among older people in Japan (aged 65+ years, N = 1,928) by multivariable logistic regression analysis, adjusting for sociodemographic characteristics. Lack of safety, low access to emergency assistance, low or high indoor temperature, poor sanitary conditions, and state of home disrepair were significantly associated with negative aspects of health among people with low activities of daily living (ADL) independence. Home care service providers and policymakers need to consider the importance of appropriate environmental conditions for the most vulnerable groups.

Social Capital and the Improvement in Functional Ability among Older People in Japan: A Multilevel Survival Analysis Using JAGES Data.

We investigated the contextual effects of community social capital on functional ability among older people with functional disability in Japan, and the cross-level interaction effects between community social capital and individual psychosocial characteristics. We used data from the Japan Gerontological Evaluation Study for 1936 men and 2207 women nested within 320 communities and followed for 46 months. We used objective data for functional ability trajectories derived from the national long-term care-insurance system, and a validated measure of health-related community social capital comprising three components: civic participation, social cohesion, and reciprocity. A multilevel survival analysis with a community-level random intercept showed that in communities with high civic participation, women who actively participated in any community group showed greater functional ability improvement than did women who did not participate (pinteraction = 0.05). In communities with high social cohesion, older men who perceived that their communities’ social cohesion was high showed greater functional ability improvement than men who perceived it to be low (pinteraction = 0.02). Community social capital can thus affect functional ability improvements variously, depending on individual psychosocial characteristics and gender. Community interventions aiming to foster social capital should focus on people who are excluded from existing opportunities to participate.

Association between neighbourhood convenience stores and independent living in older people in Japan.

On ageing, and as physical functionality declines, shopping for food and commodities can become a challenge. In Japan, convenience stores (CVSs) play an important role in older people's daily lives. This study investigated the relationship between the geographical accessibility of CVSs, supermarkets and grocery stores and shopping independence. We used the administrative long-term care insurance data from a sample of 7703 older adults. The spatial coverages of the stores were calculated using a geographic information system. A multilevel regression analysis was conducted to examine the association between neighbourhood spatial coverage and individual shopping independence. After adjusting for demographic characteristics, individual functioning and neighbourhood-level population density, the regression analysis revealed that the CVSs spatial coverage was negatively associated with a risk of shopping dependence (odds ratio=0.73, P=0.03). The findings suggest that geographical accessibility of CVSs may be beneficial for maintaining shopping independence.

The Association between Tub-Bathing Frequency and the Incidence of Depressive Symptoms among Older People in Japan: JAGES Longitudinal Study

The Association between Tub-Bathing Frequency and the Incidence of Depressive Symptoms among Older People in Japan: JAGES Longitudinal Study

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

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

Creating a common world through action: what participation in community activities means to older people

AbstractAs a response to demographic ageing, various governments have been promoting social policies that promote older people's participation in productive activities, including those outside the formal labour market. Nevertheless, older people's behaviours do not simply reflect government policies and intentions. This paper explores how older people themselves interpret their social roles within a policy context that seeks to position them as providers of welfare through their participation in community activities. For this purpose, this paper draws on a qualitative case study of older people in Japan engaging in health promotion and mutual aid among local residents. By employing Hannah Arendt's distinction between the human activities of labour, work and action as a conceptual framework, it finds that although the purported purpose of community activities was to substitute decreasing pensions and family care or to create a better community, participants in this study valued their activities as a process of creating new relations and new realities through action. The paper argues that while labour has occupied a predominant position in the post-war welfare paradigm, community activities by an expanding population of older people may offer opportunities for action, which were not always available through paid work or care-giving in the household.

Social factors relating to depression among older people in Japan: analysis of longitudinal panel data from the AGES project

Objectives: Preventing the onset of depression among older people in Japan requires clarifying the social determinants of depression by using longitudinal data, while also taking biological and psychological factors into account. Identification of such determinants may enable more active intervention through social policy. We aimed to reveal the social factors related to depression in Japan’s older people and consider associated policy implications.Method: Panel data obtained from a longitudinal survey (Wave 1 to Wave 2) of 3464 elderly subjects, aged 65 years or more, as part of the Aichi Gerontological Evaluation Study (AGES) project was employed. The outcome variable was depression, as evaluated by the Geriatric Depression Scale. Frequency of meeting with friends, social support, hobbies, participation in organizations, life events, illness, self-rated health, instrumental activities of daily living, and sense of coherence were entered as explanatory variables within a logit model for each gender.Results: Of the subjects without mental illness or depression at Wave 1, 14% had become depressed by Wave 2. In both men and women, life events predicted increased odds of depression, while sense of coherence predicted reduced odds. The frequency of meeting with friends, hobbies, and self-rated health predicted reduced odds of depression in men, while age predicted increased odds in women.Conclusion: Overall, social interaction is important for preventing depression in Japan, and that the establishment of a system capable of promoting social interaction and providing care to the elderly during life events may be a useful social policy approach to preventing depression.

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.

29Developing a Questionnaire on User Needs and Decision-Making Regarding Home-Care Robots for Older People in Japan, Ireland and Finland

29Developing a Questionnaire on User Needs and Decision-Making Regarding Home-Care Robots for Older People in Japan, Ireland and Finland

Community social capital and the improvement of functional ability among older people in Japan

Background The aim of this study was to investigate the contextual effects of community social capital on the improvement of functional ability among older people in Japan. Methods We performed a multilevel survival analysis on 1936 men and 2207 women nested within 320 communities included in Japan Gerontological Evaluation Study in 2010. We used the objective data of the functional ability trajectories based on national long-term care insurance systems. We used multilevel Weibull survival models including a community-level random intercept. We stratified the analyses by gender. We used a validated measure of community social capital that captured three components: the levels of civic participation, social cohesion, and reciprocity. Results In a community with high social cohesion, older men with the low perception of community social cohesion were less likely to improve their functional ability than older men with the high perception of community social cohesion (P for interaction = 0.007). Among women, community social cohesion was inversely associated with the improvement of functional ability regardless of the individual perception of community social cohesion. In a community with high civic participation, women who did not participate in any group in the community were less likely to improve their functional ability than women who participate in some groups (P for interaction = 0.008), whereas such cross-level interaction was not found among older men. Community reciprocity was not associated with the improvement in functional ability in men and women. Conclusion The effect of community social capital on the improvement of functional ability might differ between individuals depending on their psychosocial components in the same community. There might be older people who do not benefit from and excluded from community social capital.

Social Support and Access to Health Care Among Older People in Japan: Japan Gerontological Evaluation Study (JAGES).

We investigated cross-sectional associations between social support and access to health care among older Japanese people. From larger cohort datasets of community-dwelling people aged 65 years or older, 23 079 respondents were extracted. We summarized patterns of social support by gender and age group, then analyzed associations between social support and the experience of unmet health care needs, as a negative indicator of access. Adjusting for socioeconomic factors, multiple logistic regression identified that respondents who received instrumental support were less likely to experience unmet health care needs except males aged 65 to 69 years. The effect of receiving instrumental social support was larger than for household income and similar to anxiety about unexpected expenses. In the low-income group, these findings were highlighted among females aged 65 to 69 years and males aged 70 years and older. In addition to redistribution of financial resources, facilitating suitable social support may contribute to alleviating the access gap among older people.

The experience of older people in Japan four years after the tsunami

BackgroundWhen a disaster occurs older people are recognised to be among one of the vulnerable population groups. During the Great East Japan earthquake in 2011, there were numerous unresolved health and social issues for the survivors. Aim of the studyTo understand which challenges older people that survived the 2011 disaster faced, which aspects they identified as concerns and what they felt was difficult and possibly could not recover from in the near future. MethodsA qualitative case study method was used. Sixteen participants, living in temporary housing, were interviewed in 2015. The interview data was analysed using thematic analysis. Findings and discussionParticipants (4 men; 12 women) were aged between 65 and 89 years. Seven participants stated that they were healthy although they had minor health issues. Some women had psycho-social health issues brought about by the trauma they experienced, caring for their aging relatives and living in temporary housing. Four themes emerged: feeling grateful to be alive; issues related to health and mental health; the importance of recreational activities and community involvement; feeling of fear, uncertainty and vulnerability. ConclusionsThis is the first study to report directly participants’ feelings and views after their traumatic experience. All participants were happy to be interviewed and to express their views. Although participants expressed their need for health professional services to be available to support them following traumatic events, these services are yet to be recognised as an essential part of the recovery process.

Social and Behavioural Determinants of the Difference in Survival among Older Adults in Japan and England

Background: A rapidly ageing population presents major challenges to health and social care services. Cross-country comparative studies on survival among older adults are limited. In addition, Japan, the country with the longest life expectancy, is rarely included in these cross-country comparisons. Objective: We examined the relative contributions of social and behavioural factors on the differences in survival among older people in Japan and England. Methods: We used data from the Japan Gerontological Evaluation Study (JAGES; n = 13,176) and the English Longitudinal Study of Ageing (ELSA; n = 5,551) to analyse all-cause mortality up to 9.4 years from the baseline. Applying Laplace regression models, the 15th survival percentile difference was estimated. Results: During the follow-up, 31.3% of women and 38.6% of men in the ELSA died, whereas 19.3% of women and 31.3% of men in the JAGES died. After adjusting for age and baseline health status, JAGES participants had longer survival than ELSA participants by 318.8 days for women and by 131.6 days for men. Family-based social relationships contributed to 105.4 days longer survival in JAGES than ELSA men. Fewer friendship-based social relationships shortened the JAGES men’s survival by 45.4 days compared to ELSA men. Currently not being a smoker contributed to longer survival for JAGES women (197.7 days) and ELSA men (46.6 days), and having lower BMI reduced the survival of JAGES participants by 129.0 days for women and by 212.2 days for men. Conclusion: Compared to participants in England, Japanese older people lived longer mainly because of non-smoking for women and family-based social relationships for men. In contrast, a lower rate of underweight, men’s better friendship-based social relationships, and a lower smoking rate contributed to survival among participants in England.

Community Social Capital, Built Environment, and Income-Based Inequality in Depressive Symptoms Among Older People in Japan: An Ecological Study From the JAGES Project.

BackgroundAlthough reducing socioeconomic inequalities in depression is necessary, their associated factors have rarely been studied. This study aimed to screen the potential contextual factors associated with income-based inequality in older adults’ depression.MethodsUsing data from the Japan Gerontological Evaluation Study (JAGES) of 2013, we conducted an ecological study covering 77 communities in Japan. Our measures of socioeconomic inequalities in depression were the slope index of inequalities (SII) and the relative index of inequalities (RII) of the prevalence of depressive symptoms across three income levels. We categorized available community-level factors, including socio-demographic factors, social participation, social relationships, subjective changes in the residential area, and the built environment. These indicators were aggregated from individual responses of 51,962 and 52,958 physically independent men and women, respectively, aged 65 years or more. We performed multiple linear regression analyses to explore factors with statistical significance of a two-tailed P-value less than 0.05.ResultsFactors associated with shallower gradients in depression for men included higher participation in local activities and reception or provision of social support, which did not show significant association among women. Perceived increases in unemployment and economic inequalities were positively associated with larger inequalities in both genders (P < 0.05). The built environment did not indicate any significant association.ConclusionsA community environment fostering social activities and relationships might be associated with smaller income-based inequalities in depression. There is a need for more deterministic studies for planning of effective community interventions to address socioeconomic inequalities in depression.

Does Marriage Make Us Healthier? Evidence from Middle-Aged and Older Japanese

This study investigated health premium of marriage among middle-aged and older Japanese. Using a unique longitudinal micro dataset for Japanese aged 45–80 years in 2007, we applied a dynamic panel data model and utilized both subjective and objective health indicators for 4,386 observations from 2008 to 2012. We found significant marriage–health premium among middle-aged Japanese, while the evidence for older Japanese was inconclusive. This is the first study addressing the endogeneity between marriage and health to confirm the protective effect of marriage on health for middle-aged and older people in Japan, which sounds an alarm for Japanese health policies facing the late marriage and rising divorce rates owing to the receding economy and shifting social norms.

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

Neighborhood Characteristics and Cardiovascular Risk among Older People in Japan: Findings from the JAGES Project.

Previous studies have found an association between neighborhood characteristics (i.e., aspects of the physical and social environment) and the incidence of cardiovascular disease (CVD) and elevated CVD risk. This study investigated the relationship between neighborhood characteristics and CVD risk among older people in Japan where research on this association is scarce. Data came from the Japan Gerontological Evaluation Study project; questionnaire data collected from 3,810 people aged 65 years or older living in 20 primary school districts in Aichi prefecture, Japan, was linked to a computed composite CVD risk score based on biomarker data (i.e., hemoglobin A1c, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and estimated glomerular filtration rate). A sex-stratified multilevel linear regression analysis revealed that for male participants, living in neighborhoods with a higher perceived occurrence of traffic accidents and reduced personal safety was associated with an elevated CVD risk (coefficient = 1.08 per interquartile range increase, 95% confidence interval [CI] = 0.30 to 1.86) whereas males living in neighborhoods with a higher perceived proximity of exercise facilities had a lower risk (coefficient = −1.00, 95% CI = −1.78 to −0.21). For females, there was no statistically significant association between neighborhood characteristics and CVD risk. This study suggests that aspects of the neighborhood environment might be important for CVD morbidity and mortality in Japan, particularly among men.

Association between social participation and hypertension among older people in Japan: the JAGES Study.

Hypertension is an important risk factor for cardiovascular disease, the leading cause of mortality in the world. Although previous studies have focused on individual-level behavioral risk factors associated with hypertension, there has been little research on how interacting with others, that is social participation, affects hypertension. To address this research gap, this study examined the association between social participation and hypertension in Japan, a country with a high prevalence of hypertension possibly linked to rapid population aging. Data were used from 4582 participants aged more than 65 years who participated in the Japan Gerontological Evaluation Survey (JAGES) with blood pressure data collected during a health check-up. The frequency of participation in vertical organizations (characterized by hierarchical relationships) and horizontal organizations (characterized by non-hierarchical, egalitarian relationships) was measured by a questionnaire. In a Poisson regression analysis, participation in vertical organizations was not associated with hypertension, whereas participation in horizontal organizations at least once a month was inversely associated with hypertension (prevalence ratio: 0.941). This association remained significant after adjusting for social support variables, although further adjustment for health behaviors attenuated the association. As the frequency of going out and average time spent walking were both associated with hypertension, physical activity may be a possible pathway that connects social participation and hypertension. The results of this study suggest that expanding social participation programs, especially those involving horizontal organizations, may be one way to promote better health among older people in Japan.