Association between Internet use and depressive symptoms among older adults in two regions of Myanmar: a cross-sectional study.

BACKGROUND: Internet use has both positive and negative effects on mental health. However, few studies have examined the association between internet use and mental health among older adults in developing countries. This study aimed to investigate the association between Internet use and depressive symptoms among older adults in two regions of Myanmar. METHODS: Data based on a visit to 1,200 older adults in urban and rural Myanmar were obtained through stratified random sampling using the cross-sectional baseline survey of the longitudinal study titled "Healthy and Active Aging in Myanmar." Our analysis included 1,186 participants. The dependent variable was depressive symptoms, and the 15-item version of the Geriatric Depression Scale (GDS) was used as a continuous variable; the higher the score, the more likely a person was to be depressed. Internet use (one of the questions about household property ownership) was used as an independent variable. After confirming the absence of multicollinearity, we adjusted for age, gender, educational background, activities of daily living, residential area, and frequency of meeting friends, and stratified by subjective economic status (above or below average). We also examined the interaction between internet use and subjective economic status. A linear regression analysis was performed. RESULTS: Among the 1,186 participants included in the analysis (women: 59.5%; median age: 68 years old), 202 (17.0%) were Internet users (95% Confidential Interval [CI]: 0.15, 0.19), and they had significantly lower GDS scores than the participants who did not use the Internet (B: -1.59, 95% CI: -2.04, -1.13).GDS showed a negative association with Internet use even in the multivariate analysis (B: -0.95, 95% CI: -1.41, -0.50). However, the interaction term for GDS between Internet use and subjective economic status was not significantly associated (B: 0.43, 95% CI: -1.11, 1.98). CONCLUSIONS: Internet use and depressive symptoms were associated especially among the older adults. However, there were no significant interaction between Internet use and subjective economic status for GDS.

Association of excess visceral fat and severe illness in hospitalized COVID-19 patients in Japan: a retrospective cohort study.

BACKGROUND/OBJECTIVES: Obesity, defined by body mass index (BMI), is a well-known risk factor for the severity of coronavirus disease 2019 (COVID-19). Adipose tissue distribution has also been implicated as an important factor in the body's response to infection, and excess visceral fat (VF), which is prevalent in Japanese, may contribute significantly to the severity. Therefore, this study aimed to evaluate the association of obesity and VF with COVID-19 severe illness in Japan. SUBJECTS/METHODS: This retrospective cohort study involved 550 COVID-19 patients admitted to a tertiary care hospital with BMI and body composition data, including VF. The primary endpoint was severe illness, including death, due to COVID-19 during hospitalization. Logistic regression analysis was applied to examine the quartiles of BMI and VF on severe illness after adjusting for covariates such as age, sex, subcutaneous fat, paraspinal muscle radiodensity, and comorbidities affecting VF (COPD, cancer within 5 years, immunosuppressive agent use). RESULTS: The median age was 56.0 years; 71.8% were males. During hospitalization, 82 (14.9%) experienced COVID-19 severe illness. In the multivariate logistic regression analysis, Q4 of BMI was not significantly associated with severe illness compared to Q1 of BMI (OR 1.03; 95% CI 0.37-2.86; p = 0.95). Conversely, Q3 and Q4 of VF showed a higher risk for severe illness compared to Q1 of VF (OR 2.68; 95% CI 1.01-7.11; p = 0.04, OR 3.66; 95% CI 1.30-10.26; p = 0.01, respectively). Stratified analysis by BMI and adjusted for covariates showed the positive association of VF with severe illness only in the BMI < 25 kg/m2 group. CONCLUSIONS: High BMI was not an independent risk factor for COVID-19 severe illness in hospitalized patients in Japan, whereas excess VF significantly influenced severe illness, especially in patients with a BMI < 25 kg/m2.

Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study.

OBJECTIVES: This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference. DESIGN: Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region. SETTING: An urban and a rural area in Myanmar. PARTICIPANTS: A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256). OUTCOME: Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables. RESULTS: We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37-7.58; monastic: 3.42, 1.16-5.07; primary school: 2.41, 1.18-4.95), but wealth and income did not show similar associations. CONCLUSIONS: SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised.

Digital-Based Policy and Health Promotion Policy in Japan, the Republic of Korea, Singapore, and Thailand: A Scoping Review of Policy Paths to Healthy Aging.

People are living longer, and our life has become more digital. Hence, the benefits from digital technology, including economic growth, increasing labor productivity, and ensuring health equity in the face of an aging population emerged as a vital topic for countries around the world. Japan, the Republic of Korea (ROK), Singapore, and Thailand are in the top ten rankings in terms of information and communication technology (ICT) development within the Asia Pacific Region and all are facing challenges of population aging. Well-designed national ICT policy and health promotion policies enabled the countries to make significant progress and development in terms of digitalization and healthy aging. This paper aims to answer questions regarding digitization and health promotion: when it started, how it is going, what are the achievements, and what it holds for the future, considering healthy aging and digitalization by reviewing the national ICT policy and health promotion policies of Japan, Korea, Singapore, and Thailand. This paper is expected to help readers build a comprehensive understanding of each country's journey towards building a healthy aging digital society. Furthermore, we hope this paper can be a source for countries to exchange experiences and learn from each other with a joint goal of building a healthy aging digital society.

Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study.

BACKGROUND: Hypertension is a major cause of morbidity among older adults. We investigated older adults' access to health services in Myanmar by focusing on unmet needs in diagnosing hypertension. This study aims to identify factors associated with the unmet needs for hypertension diagnosis in the study areas of Myanmar. METHODS: This is a secondary data analysis of the survey which is a cross-sectional study conducted with older adults (aged ≥ 60 years) in the Yangon and Bago regions of Myanmar. Objective indicators of health were collected, including blood pressure, height and weight. The diagnosis of hypertension was considered an unmet need when a participant's blood pressure measurement met the diagnostic criteria for hypertension but the disease had not yet been diagnosed. Bivariate and multivariate analyses using logistic regression were performed to identify factors associated with the unmet need for hypertension diagnosis. Factors related to lifestyle habits and medical-seeking behaviour were selected and put into the multivariate model. RESULTS: Data from 1200 people, 600 from each of the two regions, were analysed. Altogether 483 (40.3%) participants were male, 530 (44.2%) were aged ≥ 70 years, and 857 were diagnosed with hypertension based on their measured blood pressure or diagnostic history, or both, which is a 71.4% prevalence of hypertension. Moreover, 240 (20.0%) participants had never been diagnosed with hypertension. In the multivariate analysis, these unmet needs for hypertension diagnosis were significantly associated with male sex (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05-2.05), residence in the Bago region (OR 1.64, 95% CI 1.09-2.45) and better self-rated health (OR 1.70, 95% CI 1.24-2.33), but not with education, category on the wealth index or living arrangement. CONCLUSIONS: There are barriers to accessing health services for hypertension diagnosis, as evidenced by the regional disparities found in this study, and charitable clinics may decrease the financial barrier to this diagnosis.

Digitally Inclusive, Healthy Aging Communities (DIHAC): A Cross-Cultural Study in Japan, Republic of Korea, Singapore, and Thailand.

One out of three people in Japan will be an older person before 2040. Half of those currently do not utilize the internet, smartphone apps, or digital technology. On the other hand, more than 70% of seniors in Republic of Korea use the internet, and 55% in Singapore had access to it in 2019. The use of digital technology for health promotion has the potential to promote individual and community empowerment, advocating for healthy, active aging. Maintaining equity in health promotion practice requires the digital inclusion of every senior. Therefore, we propose a cross-cultural study to explain the contextual influences of digital inclusion and its consequences on healthy aging in Japan, Korea, Singapore, and Thailand. Quantitatively: digital skills, e-health literacy, participation in health promotion, and quality of life will be analyzed in structural equation models. Qualitatively: thematic analysis will be developed to identify cultural patterns and contextual factors, making sense of what older persons in different countries materialize, say, do, think, and feel to reveal deeper beliefs and core values about digital inclusion and healthy aging. Logics and methods from this protocol would be useful to replicate the study in many countries globally. Evidence from this study is expected to pave the way to digitally inclusive, healthy aging communities (DIHAC) across Japan and Asia.

Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions.

Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking "Which of the following best describes your current financial situation in light of general economic conditions?" Responses ranged from "very difficult" to "very comfortable". Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.

Rural-Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar.

The aim of the study was to investigate rural-urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = -0.61; 95% CI: -0.94, -0.28) and the frequency of visits to religious facilities (B = -0.20; 95% CI: -0.30, -0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = -0.67; 95% CI: -1.23, -0.11), middle or high wealth index (B = -0.92; 95% CI: -1.59, -0.25) and the frequency of visits to religious facilities (B = -0.20; 95% CI: -0.38, -0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = -0.62; 95% CI: -1.12, -0.12) and the frequency of visits to religious facilities (B = -0.44; 95% CI: -0.68, -0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.

Association between depressive symptoms and objective/subjective socioeconomic status among older adults of two regions in Myanmar.

Low objective socioeconomic status (SES) has been correlated with poor physical and mental health among older adults. Some studies suggest that subjective SES is also important for ensuring sound physical and mental health among older adults. However, few studies have been conducted on the impact of both objective and subjective SES on mental health among older adults. This study examines whether objective or subjective SES is associated with depressive symptoms in older adults in Myanmar. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from two regions of Myanmar, for face-to-face interviews. The Geriatric Depression Scale (GDS) was used to evaluate the depressive symptoms. Participants were classified as having no depressive symptom (GDS score <5) and having depressive symptoms (GDS score ≥5). Objective and subjective SES were assessed using the wealth index and asking participants a multiple-choice question about their current financial situation, respectively. The relationship between objective/subjective SES and depressive symptoms was examined using a multivariable logistic regression analysis. The mean age of the 1,186 participants aged 60 years and above was 69.7 (SD: 7.3), and 706 (59.5%) were female. Among them, 265 (22.3%) had depressive symptoms. After adjusting for objective SES and other covariates, only low subjective SES was positively associated with depressive symptoms (adjusted odds ratio, AOR: 4.18, 95% confidence interval, CI: 2.98-5.87). This association was stronger among participants in the rural areas (urban areas, AOR: 2.10, 95% CI: 1.08-4.05; rural areas, AOR: 5.65, 95% CI: 3.69-8.64). Subjective SES has a stronger association with depressive symptoms than objective SES, among older adults of the two regions in Myanmar, especially in the rural areas. Interventions for depression in older adults should consider regional differences in the context of subjective SES by reducing socioeconomic disparities among the communities.

[Types and number of hobbies and incidence of dementia among older adults: A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES)].

Objectives　Dementia prevention is an important issue in the current super-aging society. Previous studies have shown a low risk of dementia in older adults who have hobbies, especially gardening, tourism, and those that are sports-based. However, it is unclear whether the effect of dementia prevention differs according to the specific type and number of hobbies. This study aims to clarify the relationship of dementia onset with the type and number of hobbies practiced by a person.Methods　This prospective cohort study conducted between 2010 and 2016 by the Japan Gerontological Evaluation Study surveyed 56,624 functionally independent individuals aged 65 years and over who had non-missing information on age and gender. A total of 49,705 participants who provided valid answers to the question regarding hobbies, and were followed for 365 days or more, were analyzed. The primary outcome of this study was dementia, which was assessed by the nationally standardized dementia scale proposed by the Ministry of Health, Labour, and Welfare of Japan. Explanatory variables were specific types of hobbies practiced by 5% or more of older adults (males: 14 types and females: 11 types) and the number of hobbies an individual engaged in (0~5 types or more). The covariates were basic characteristics, diseases, health behavior, social support, psychology/cognition, and instrumental activities of daily living. Hazard ratios (HRs) were calculated using the Cox proportional hazards model adjusted for a total of 22 variables.Results　In total, 4,758 patients (9.6%) developed dementia during the follow-up period. The following hobbies were related to a lower risk of developing incident dementia: a) both in males and females, ground golf (HR: males, 0.80; females, 0.80) and travel (males, 0.80; females, 0.76); b) only in males, golf (0.61), use of a personal computer (0.65), fishing (0.81), and photo shooting (0.83); and c) only in females, handicrafts (0.73), and gardening (0.85). A significant trend was observed indicating that the risk of dementia was lower as the number of hobbies increased for both males and females (males, 0.84; females, 0.78).Conclusion　The results of this study suggest that both male and female older adults who engaged in ground golf and travel as a hobby had a lower risk of developing dementia, and the risk decreased as the number of hobbies increased. Providing an environment in which older adults can engage in various hobbies that are associated with less risk of developing dementia, may be an effective measure for preventing dementia.

Cohort profile: healthy and active ageing in Myanmar (JAGES in Myanmar 2018): a prospective population-based cohort study of the long-term care risks and health status of older adults in Myanmar.

PURPOSE: Myanmar is rapidly ageing. It is important to understand the current condition of older adults in the country. To obtain such information, we conducted home-visit surveys to collect data for evaluating social determinants of health on older adults in Yangon (representative of an urban) and Bago (representative of a rural) regions of Myanmar. PARTICIPANTS: Overall, 1200 individuals aged 60 years or older and who were not bedridden or had severe dementia (defined as an Abbreviated Mental Test score ≤6) were recruited from Yangon and Bago in 2018. A population-proportionate random-sampling method was used for recruitment. FINDINGS TO DATE: Overall, 600 individuals from Yangon (222 men; 378 women) and 600 from Bago (261 men; 339 women) were surveyed. The average age of Yangon-based men and women was 69.4±7.6 and 69.4±7.3 years; in Bago, this was 69.2±7.1 and 70.6±7.5 years, respectively. Compared to their Yangon-based counterparts, Bago-based respondents showed significantly lower socioeconomic status and more commonly reported poor self-rated health (Bago-based men: 32.2%, women: 42.5%; Yangon: 10.8% and 24.1%, respectively). Meanwhile, some Yangon-based respondents rarely met friends (men: 17.1%, women: 27.8%), and Yangon-based respondents scored higher for instrumental activities of daily living and body mass index when compared to their Bago-based counterparts. For both regions, women showed higher physical-function decline (Yangon-based women: 40.7%, men: 17.1%; Bago: 46.3% and 23.8%, respectively) and cognitive-function decline (Yangon: 34.1% and 10.4%, respectively; Bago: 53.4% and 22.2%, respectively). Being homebound was more common in urban areas (urban-based men: 11.3%, rural-based men: 2.3%; urban-based women: 13.0%, rural-based women: 4.7%, respectively). FUTURE PLANS: A follow-up survey is scheduled for 2021. This will afford longitudinal data collection concerning mortality, becoming bedridden, and developing dementia and long-term care-related diseases. This will allow us to calculate long-term care risks for older adults in Myanmar.

Social Participation and Functional Decline: A Comparative Study of Rural and Urban Older People, Using Japan Gerontological Evaluation Study Longitudinal Data.

This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.

Dementia risk by combinations of metabolic diseases and body mass index: Japan Gerontological Evaluation Study Cohort Study.

AIMS/INTRODUCTION: To compare the dementia risk associated with pre-existing diabetes, hypertension, dyslipidemia, obesity (body mass index [BMI] ≥25 kg/m2 ) and underweight (BMI <18.5 kg/m2 ) among older adults. We also explored the dementia risk associated with combinations of metabolic diseases and BMI. MATERIALS AND METHODS: We used data from the Japan Gerontological Evaluation Study. Participants completed a health checkup in 2010 and were followed for 5.8 years on average. Dementia was measured by municipal long-term care insurance registration. Diabetes, hypertension, dyslipidemia, obesity and underweight were diagnosed by medication use or health examination results. We calculated the incidence of dementia and adjusted hazard ratios (HRs). RESULTS: Among 3,696 participating older adults, 338 developed dementia. Adjusted HRs (95% confidence intervals) in men and women (reference: those without corresponding disease of normal weight) were as follows: 2.22 (1.26-3.90) and 2.00 (1.07-3.74) for diabetes; 0.56 (0.29-1.10) and 1.05 (0.64-1.71) for hypertension; 1.30 (0.87-1.94) and 0.73 (0.49-1.08) for dyslipidemia; 0.73 (0.42-1.28) and 0.82 (0.49-1.37) for BMI of 25-29.9 kg/m2 ; and 1.04 (0.51-2.10) and 1.72 (1.05-2.81) for underweight. Dementia risk was significantly higher in underweight men with dyslipidemia (HR 4.15, 95% CI 1.79-9.63) compared with normal-weight men without dyslipidemia, and in underweight women with hypertension (HR 3.79, 1.55-9.28) compared with normal-weight women without hypertension. Dementia incidence was highest among underweight older adults with hypertension followed by dyslipidemia. CONCLUSIONS: Among Japanese older adults, underweight and prevalent diabetes are risk factors for developing dementia. Lower BMI is also associated with a higher incidence of dementia.

Gender Difference in the Association Between Subjective Socioeconomic Mobility Across Life Course and Mortality at Older Ages: Results From the JAGES Longitudinal Study.

BACKGROUND: Socioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages. METHODS: Participants were 16,690 community-dwelling adults aged 65-100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants' vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: 'persistently high', 'downward mobility', 'upward mobility', and 'persistently low'. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality. RESULTS: Mortality HRs for the 'downward' group were 1.37 (95% confidence interval [CI], 1.08-1.74) among men and 1.27 (95% CI, 0.94-1.71) among women in comparison with the 'persistently high' group. Compared to the 'persistently low' group, the HRs for the 'upward' group were 0.54 (95% CI, 0.35-0.83) among women and 0.91 (95% CI, 0.73-1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression. CONCLUSIONS: 'Downward' mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.

Suicide Rates, Social Capital, and Depressive Symptoms among Older Adults in Japan: An Ecological Study.

Depression is considered the primary risk factor for older people's suicide. When considering suicide measures, it is necessary to clarify the relationship between depressive symptoms, social capital, and suicide rates. Therefore, we aimed to clarify the relationship between community-level social capital, depressive symptoms, and suicide rates among older people in Japan. We analyzed the data gathered from 63,026 men and 72,268 women aged 65 years and older, totaling 135,294 subjects in 81 municipalities with a population of over 100,000 participants in the 2013 Sixth Long-Term Care Needs Survey and another survey conducted by Japan Gerontological Evaluation Study (JAGES) in 2013 including the same question items as the survey in Japan. Multiple regression analysis revealed that the male suicide standardized mortality ratio (SMR) was positively correlated with depressive symptoms (B = 2.318, p = 0.002), and received emotional support (B = -2.622, p = 0.014) had a negative correlation with the male suicide SMR. In older males particularly, the received emotional support in the community was independently associated with the suicide rate. Therefore, fostering social support in a community could act as a countermeasure to suicide among older males in Japan.

Socio-economic status and dementia onset among older Japanese: A 6-year prospective cohort study from the Japan Gerontological Evaluation Study.

OBJECTIVES: Lower socio-economic status (SES) may be associated with dementia later in life, but there is inconsistent evidence supporting this claim. We aim to examine the association between three SESs (education, job, and income indicators) and dementia onset in older adults. METHODS: Study design was a 6-year prospective cohort study. Participants included a total of 52 063 community-dwelling adults aged 65 years or older without long-term care needs from the Japan Gerontological Evaluation Study. Outcome variable was dementia onset. Explanatory variables were educational years, the longest job held, and equivalised household income. We performed Cox proportional hazard analysis by gender with multiple imputation. RESULTS: During the follow-up period, 10.5% of participants acquired dementia. The adjusted risks of dementia incidence of the participants with less than 6 years of education were 1.34 times (95% confidence interval [CI], 1.04-1.73) in men and 1.21 (1.00-1.45) times in women higher than those with more than 13 years of education. Females with less than 1.99 million yen (hazard ratio = 0.83, 0.72-0.96) of equivalised income were less likely to acquire dementia than those with four million yen or higher. CONCLUSIONS: Educational attainment had a robust impact on dementia onset compared with the other SES factors in both genders of older Japanese people. Securing an education for children could be crucial to prevent dementia later in life. The longest job held was less likely to be risks of dementia incidence, compared with the other two factors.

Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010.

BACKGROUND: Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce. METHODS: We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval. RESULTS: A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07-1.90) for women and 1.16 (95% CI, 0.90-1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population. CONCLUSIONS: Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.

Bathing Frequency and Onset of Functional Disability Among Japanese Older Adults: A Prospective 3-Year Cohort Study From the JAGES.

BACKGROUND: While bathing styles vary among countries, most Japanese people prefer tub bathing to showers and saunas. However, few studies have examined the relationship between tub bathing and health outcomes. Accordingly, in this prospective cohort study, we investigated the association between tub bathing frequency and the onset of functional disability among older people in Japan. METHODS: We used data from the Japan Gerontological Evaluation Study (JAGES). The baseline survey was conducted from August 2010 through January 2012 and enrolled 13,786 community-dwelling older people (6,482 men and 7,304 women) independent in activities of daily living. During a 3-year observation period, the onset of functional disability, identified by new certification for need of Long-Term Care Insurance, was recorded. Tub bathing frequencies in summer and winter at baseline were divided into three groups: low frequency (0-2 times/week), moderate frequency (3-6 times/week), and high frequency (≥7 times/week). We estimated the risks of functional disability in each group using a multivariate Cox proportional hazards model. RESULTS: Functional disability was observed in a total of 1,203 cases (8.7%). Compared with the low-frequency group and after adjustment for 14 potential confounders, the hazard ratios of the moderate- and high-frequency groups were 0.91 (95% confidence interval [CI], 0.75-1.10) and 0.72 (95% CI, 0.60-0.85) for summer and 0.90 (95% CI, 0.76-1.07) and 0.71 (95% CI, 0.60-0.84) for winter. CONCLUSION: High tub bathing frequency is associated with lower onset of functional disability. Therefore, tub bathing might be beneficial for older people's health.

Long-term Impact of Childhood Disadvantage on Late-Life Functional Decline Among Older Japanese: Results From the JAGES Prospective Cohort Study.

Background: Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study. Methods: Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years). Results: A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group. Conclusions: These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context.