[A longitudinal study of the association between physical activity and apathy among community-dwelling older adults].

AIM: This study clarified the association between the amount of physical activity and apathy after one year among community-dwelling older adults. METHODS: Two hundred community-dwelling older adults (mean age: 74.3±5.0 years old, female: 52.5%) who participated in the 2018 and 2019 "Kasama Longevity Health Examination" were included. Apathy was assessed using the Apathy Scale (0-42 points; the higher the score, the lower the motivation), physical activity by Physical Activity Scale for the Elderly (PASE), and Geriatric Depression Scale-15 (GDS). The 2018 PASE data were grouped into tertiles. A multiple regression analysis was performed with the 2019 Apathy Scale as the dependent variable and the 2018 PASE as the independent variable, and the sex, age, years of education, economic situation, body mass index, chronic illness, smoking history, alcohol drinking habits, physical function, cognitive function, GDS, and the 2018 Apathy Scale as adjustment variables. The PASE subcategories (leisure-time, household, and work-related activities) were examined using a similar method. RESULTS: The mean Apathy Scale in 2019 was 14.0±6.2 for the low physical activity group, 12.8±6.0 for the medium physical activity group, and 10.1±5.9 for the high physical activity group. The high physical activity group showed a significant negative association with the Apathy Scale (B=-1.56, 95% confidence interval=-2.91 to -0.21, p=0.023). No association was found for any activity of the PASE sub-items. CONCLUSIONS: A high level of physical activity may protect against apathy among community-dwelling older adults.

Community-level group sports participation and all-cause, cardiovascular disease, and cancer mortality: a 7-year longitudinal study.

BACKGROUND: Community-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. METHODS: In this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. "Participation" was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS: Among the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0-52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83-0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81-0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82-1.09). CONCLUSIONS: Our findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups.

Do changes in the frailty score differ by the type of group sports and exercises participated in? A 3-year longitudinal study.

BACKGROUND: Older adults who engage in group sports and exercises achieve greater health benefits than those who exercise by themselves. The benefits of group participation may vary depending on the type of sports/exercise they engage in. The present study aimed to identify the association between specific sports and exercise types performed in groups and evaluate the longitudinal changes in multidimensional frailty scores among community-dwelling older adults in Japan. METHODS: We used 3-year follow-up data from the Japan Gerontological Evaluation Study and analyzed 33,746 men and 36,799 women aged ≥ 65 years. To elucidate the relationship between participation in 20 types of group sports/exercises in 2016 (baseline) and the change in frailty score (using the Kihon Checklist, KCL) from 2016 to 2019, we performed linear regression analyses through multivariate adjustments for age group, self-rated health, marital status, living alone, occupational status, years of education, alcohol drinking status, smoking status, equivalent income, and disease status using an inverse probability weighting method. P < 0.05 was considered statistically significant. RESULTS: The mean change in KCL scores over 3 years was + 0.62 and + 0.61 points in men and women, respectively, implying the degree of frailty worsened. The sports/exercise types that significantly prevented increments in KCL scores for both sexes compared to non-participants were hiking (men: B, - 0.36; women: B, - 0.29), walking (men: B, - 0.26; women: B, - 0.24), tennis (men: B, - 0.23; women: B, - 0.24), ground golf (men: B, - 0.21; women: B, - 0.19), and weight exercises (men: B, - 0.19; women: B, - 0.16). CONCLUSION: Participation in specific sports and exercise groups offer significant physical and psychological benefits for frailty prevention among older adults in Japan. The results of this study may offer substantive evidence to encourage older adults to participate in group activities for the prevention of multidimensional frailty. It will also help public health stakeholders to decide which type of sports and exercise groups to promote in a community.

Effectiveness of Sports Nutrition Education Based on Self-Determination Theory for Male University Rowing Athletes: A Randomized Controlled Trial.

To resolve problems in the dietary life of university athletes, education is essential to enable athletes to change their own dietary behavior. The purpose of this research was to verify the effectiveness of sports nutrition education based on self-determination theory (SDT). The participants were 36 male university rowers. A stratified randomized comparison test was conducted by student year (SDT group and control group). Sports nutrition education was held three times, via an Internet conferencing system. Furthermore, group work over social media was used for the SDT group. Four evaluations were carried out based on anthropometric measurements, a brief self-administered diet history questionnaire (BDHQ), sports nutrition knowledge test (SNK), and treatment self-regulation questionnaire (TSRQ). The results showed no differences between the two groups. However, for the intragroup factor, "Protein", a significant difference was evident in the self-determination theory group (50.0 ± 28.5, 78.6 ± 28.1, 81.0 ± 21.5, p < 0.000, units: %) and improved knowledge (p = 0.002, p = 0.002). And for the BDHQ, the self-determination theory group also showed significant differences and increased their intake of green and yellow vegetables, fruits, and dairy products (159.1 ± 74.2-126.7 ± 70.6, p = 0.009, 306.0 ± 196.2-195.2 ± 146.1, p = 0.020, 257.0 ± 147.0-183.3 ± 167.9, p = 0.040, units: g). In conclusion, sports nutrition education based on SDT improved dietary knowledge and increased food requirements for athletes.

Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan Gerontological Evaluation Study.

OBJECTIVES: The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset. METHODS: This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated. RESULTS: We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p = 0.002), lower income (males: 1.64, [1.34-2.01], p < 0.001/females: 1.82, [1.49-2.22], p < 0.001), and fewer assets (males: 1.40, [1.16-1.68], p < 0.001/females: 1.21, [1.02-1.42], p = 0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously. CONCLUSIONS: All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.

The relationship between acceleration in sit-to-stand and falls in community-dwelling older adults: cross-sectional study.

[Purpose] This study aimed to determine the relationship between acceleration parameters in the sit-to-stand (STS) movement and falls, and the strength of the association between acceleration in STS movements and falls in older adults. [Participants and Methods] In total, 330 older adults were included. Four acceleration parameters were measured in STS movement: maximum acceleration (MA), velocity (MV), power (MP), and stand-up time (ST). For the conventional STS tests, 5 times STS test (5xSTS) and ground reaction force (maximal rate of force development per body weight: RFD/w, peak reaction force per body weight: F/w, chair-rise time: T) were measured. Poisson regression analysis adjusted for confounding factors was used. [Results] In the model adjusted for confounders, significant associations were observed among MV (Prevalence ratio (PR): 0.75; 95% confidence interval (CI): 0.58-0.98), MP (PR: 0.67; 95% Cl: 0.68-0.93), RFD/w (PR: 0.70; 95% Cl: 0.56-0.87), and T (PR: 1.14; 95% Cl: 1.05-1.24). [Conclusion] Among the acceleration parameters, MP was most strongly associated with falls and was considered the most useful parameter for evaluation. In addition, comparisons with the conventional chair rise tests suggested that MP was stronger than the 5xSTS test and may be equally related to the RFD/w.

Comparison of the Incidence of Functional Disability Correlated With Social Participation Among Older Adults in Japan.

BACKGROUND: Japan, which has the world's longest life expectancy, has been reporting rejuvenation of physical function among its older adult population. However, evidence for the incidence of functional disability is limited. This study aimed to investigate the comparison in the incidence of functional disability. DESIGN: We used data from the Japan Gerontological Evaluation Study. SETTING AND PARTICIPANTS: The participants were 2 nonoverlapping cohorts of 22,522 (2010-2013 cohort) and 26,284 (2016-2019 cohort) individuals aged 65 years and older from 5 municipalities who were followed for 3 years each. METHODS: The incidence rates of functional disability during the 3-year follow-up period were compared between cohorts. To examine the incident differences between the cohorts, we adjusted for social participation and 9 additional factors that would be expected to improve with social participation using the Weibull survival models adjusting for municipalities as random effects. The analysis was stratified by age groups (65-74 years old and ≥75). RESULTS: The incidence rate of functional disability per 10,000 person-years decreased from 68.6 (2010-2013 cohort) to 51.4 (2016-2019 cohort) in the 65 to 74 years old group and 380.0 (2010-2013 cohort) to 282.6 (2016-2019 cohort) in the ≥75 group; the hazard ratios (95% CIs) were 0.75 (0.64-0.89) and 0.73 (0.67-0.80), respectively. However, these significant decreases disappeared with adjustments for social participation and additional factors. CONCLUSIONS AND IMPLICATIONS: The incidence of functional disability decreased in a recent cohort, which may be explained by social participation and possibly related factors. Promoting social participation could contribute to a decreasing incidence of functional disability among older adults.

Association between comorbidities associated with diabetes and higher-level functional status in older patients with type 2 diabetes mellitus: a cross sectional study.

PURPOSE: To investigate the association between comorbidities associated with diabetes and higher-level functional status as well as the relationship between comorbidities associated with diabetes and higher-level functional status in older patients with type 2 diabetes mellitus who have better social networks. METHODS: Participants were outpatients with type 2 diabetes aged ≥ 65 years, excluding individuals with severe cardiovascular or respiratory illness, hyperglycaemic crisis, type 1 diabetes, or diabetic foot. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to evaluate the higher-level functional status. A TMIG-IC score of ≤ 9, instrumental activities of daily living (IADL) ≤ 4, intellectual activity or social role ≤ 3 were defined as decline in higher-level functional status. The comorbidities investigated included peripheral neuropathy, retinopathy, nephropathy, cognitive impairment, depression, frailty, sarcopenia, low muscle strength, stroke, heart disease, and arthritis. RESULTS: The analysis included 198 patients (mean age 75.9 ± 5.7 years, male 60.1%). After adjusting for potential confounders, depression was associated with TMIG-IC (Prevalence ratio (PR) 2.34, 95% confidence interval (CI) 1.44-3.82), low muscle strength was associated with IADL (PR 2.85, 95% CI 1.30-6.27), and frailty was associated with intellectual activity (PR 1.38, 95% CI 1.10-1.74). In the model with social networks added as a confounder, the relationship between depression or low muscle strength and higher-level functional status was not statistically significant. CONCLUSION: Comorbidities of depression and low muscle strength for older patients with type 2 diabetes mellitus increase the risk of malfunctioning of higher-level functional status. Increased interactions with family, friends and neighbours may reduce this event.

Sedentary behavior and the combination of physical activity associated with dementia, functional disability, and mortality: A cohort study of 90,471 older adults in Japan.

OBJECTIVE: To examine the associations of sedentary behavior (SB) and the combination of moderate-to-vigorous intensity physical activity (MVPA) with dementia, functional disability, and mortality in older adults, and the heterogeneity in different subpopulations. METHODS: Nation-wide cohort with 90,471 individuals aged ≥65 years in Japan. SB (<3, 3-<8, and ≥ 8 h per day [h/d]) and MVPA (0, 0 < MVPA<1, and ≥ 1 h/d) were measured in 2016. Long-term care registry-based incidence of outcomes was ascertained through 2021. Cox proportional hazard models were performed. RESULTS: Compared with SB < 3 h/d group, SB ≥ 8 h/d was associated with higher risks of dementia, functional disability, and mortality with hazard ratios (95% confidence interval) of 1.36 (1.22-1.52), 1.32 (1.19-1.48), and 1.31 (1.18-1.45). The combination of MVPA and SB demonstrated a dose-respond trend of increasing risks of dementia, functional disability, and mortality with increased SB and decreased MVPA, where participants who spent no MVPA with SB ≥ 8 h/d had the highest risks. High MVPA attenuated but didn't eliminate the risks. Participants who spent MVPA≥1 h/d with SB ≥ 8 h/d had comparable risks to those who spent no MVPA with SB < 3 h/d. No heterogeneity was found by MVPA levels, sex, education, comorbidity, and depression conditions. CONCLUSIONS: Prolonged daily SB was associated with higher risks of dementia, functional disability, and mortality in older adults, regardless of MVPA, sex, education, and chronic conditions. Individuals with high MVPA also face considerable risks when engaging in high SB. High MVPA with high SB revealed a comparable risk to no MVPA with low SB.

Does eating with others promote happiness among older adults living alone? A 3-year longitudinal study of the Japan gerontological evaluation study.

OBJECTIVE: Living a happy life is an essential issue for old adults. However, how eating with others contributes to happiness and whether this association is different by living arrangements or not is unknown. The current study examined the relationship between the frequency of eating with others and happiness among older adults according to their living arrangements using 3-year longitudinal data. METHODS: The analyzed sample comprised 18,727 people (10,920 males and 7807 females) with low happiness (0-7 points on score of 0-10 points) from Japan Gerontological Evaluation Study (JAGES) in 2016. Our exposure was the frequency of eating with others: rarely, a few times a year, a few times a month, and a few times a week or more. We performed Modified Poisson Regression to examine the association between the frequency of eating with others and high happiness (8-10 points) in 2019 stratified by living arrangement (living alone/with others). RESULTS: A total of 4352 (23.2%) people showed high happiness in 2019. After adjusting for age, sex, marital status, education, household income, social participation, illnesses under treatment, and depressive symptoms in 2016, the cumulative incidence ratio (CIR) for high happiness in 2019 among people living alone was more significant, that is, 1.28 (95% confidence intervals: 0.88-1.87), 1.50 (1.05-2.14), and 1.82 (1.26-2.63), than 1.28 (1.11-1.48), 1.30 (1.12-1.50), and 1.33 (1.16-1.52) among people living with others for those who ate with others a few times a year, a few times a month, and a few times a week or more compared to those who rarely ate with others, respectively. The interaction between the frequency of eating with others and living arrangements was statistically significant. The trend test showed that higher frequency of eating with others was significantly associated with high happiness. CONCLUSIONS: Eating with others was associated with improved happiness among older adults, with such an association being stronger among people living alone.

Relationship between Acceleration in a Sit-To-Stand Movement and Physical Function in Older Adults.

Acceleration parameters in sit-to-stand (STS) movements are useful for measuring lower-limb function in older adults. The purpose of this study was to examine the relationship between acceleration in STS movements and physical function and the test-retest reliability of acceleration parameters in older adults. We performed cross-sectional analyses on 244 older adults including 107 men (mean age: 77.4 ± 4.7) and 137 women (mean age: 75.6 ± 5.3). Four acceleration parameters were measured in STS movements: maximum acceleration (MA), maximum velocity (MV), maximum power (MP), and stand-up time (ST). Good intraclass correlation coefficients (ICC > 0.70) were observed for all parameters. For the acceleration parameters, MA, MV, and MP were relatively strongly associated with the 5-time STS test (men: r = -0.36~-0.47; women: r = -0.37~-0.45) and the timed up and go test (men: r = -0.39~0.47, women: r = -0.43~-0.51): MP was also strongly associated with grip strength (men: r = 0.48, women: r = 0.43). All acceleration parameters were poorer in participants reporting mobility limitations than in those reporting no mobility limitations. These findings support the usefulness of sensor-based STS measurement. The system is expected to be useful in various settings where care prevention is addressed.

Participation in Community Gathering Places and Subsequent Health and Well-Being: An Outcome-Wide Analysis.

Background and Objectives: Evidence remains inadequate regarding the benefits of participation in community gathering places, which is Japan's primary strategy for preventing functional disability in older adults, in other domains of health and well-being. This longitudinal study examined the associations of participation in community gathering places with an array of subsequent health and well-being outcomes among older adults. Research Design and Methods: We used 3-wave data (2013, 2016, and 2019) from Japan Gerontological Evaluation Study (n = 5 879 or 4 232 depending on the outcome). Our exposure was participation in community gathering places in 2016. We assessed 34 health/well-being outcomes in 2019 across 6 domains. We adjusted for pre-baseline covariates including prior outcome values in 2013. Results: Compared with nonparticipation, participation in community gathering places was associated with some outcomes in the following 3 domains: physical/cognitive health (better higher-level functional capacity), social well-being (more frequent participation in hobby groups, senior citizens clubs, learning or cultural groups, and seeing more friends within a month), and prosocial/altruistic behaviors (more frequent participation in volunteering; after Bonferroni correction as p < .0015, .05/34). Discussion and Implications: Evidence was mixed and more modest for the outcomes in three other domains, mental health, psychological well-being, and health behaviors. Promoting participation in community gathering places may not only fulfill its original goal (ie, preventing functional disability) but also enhance other domains of human well-being, potentially by increasing social interactions.

Association of community-level social capital with dementia: A multilevel nine-year longitudinal study using data from the Japan Gerontological Evaluation Study.

BACKGROUND: Individual-level social capital prevents cognitive decline. However, a few studies have focused on the effects of community-level social capital on dementia. Therefore, we investigated the association between community-level social capital and dementia onset based on longitudinal study data on older adults in Japan. METHODS: We used longitudinal data from the Japan Gerontological Evaluation Study, obtained over nine years (2010-2019). In total, 35,921 physically and cognitively independent individuals (16,848 males and 19,073 females) aged ≥65 years and nested within 308 communities in seven municipalities participated in the study. Dementia onset was assessed using the public long-term care insurance registration. Social capital was assessed using three dimensions: civic participation, social cohesion, and reciprocity. We performed a two-level multilevel survival analysis stratified by sex, calculated hazard ratios (HRs), and 95% confidence intervals (CIs). RESULTS: During the follow-up, 6245 (17.4%) dementia onset cases were identified. The cumulative incidence of dementia was 16.2% in males and 18.4% in females. After adjusting for covariates, individual-level civic participation was associated with a lower incidence of dementia in both males and females (HR, 0.84; 95% CI, 0.77-0.92; HR, 0.78; 95% CI, 0.73-0.84). Community-level civic participation and social cohesion were associated with a lower incidence of dementia among females (HR, 0.96; 95% CI, 0.93-0.99; HR, 0.93; 95% CI, 0.88-0.98) and cross-level interaction on social cohesion among females (HR, 0.95; 95% CI, 0.90-0.99). CONCLUSIONS: Living in a community with high civic participation and social cohesion is associated with a lower incidence of dementia among older females. Therefore, promoting civic participation and social cohesion in the community may be a useful population-based strategy to delay or prevent the onset of dementia.

Characteristics and Related Factors of One-year Transition in Exercise Tolerance Following an Emergency Declaration due to the Coronavirus Disease 2019 Pandemic in Patients on Phase III Cardiac Rehabilitation.

OBJECTIVE: This study aimed to understand the long-term transition of exercise tolerance in patients on phase III cardiac rehabilitation (CR) and clarify the characteristics of patients with a high risk of declined exercise tolerance during the first emergency declaration. METHODS: Patients who participated in phase III outpatient CR before the first emergency declaration and those who performed cardiopulmonary exercise testing were at ≥2-time points: before and at 3 or 12 months post-emergency declaration. Exercise tolerance transition at 3-time points was analyzed, and whether different social background factors affected the peak oxygen uptake (V̇O2) transition method remains to be examined. RESULTS: A total of 101 (median age 74.0 years, 69% men), and both peak V̇O2 and anaerobic threshold (AT) significantly declined from pre-declaration to 3 months post-declaration but recovered to levels likely similar from pre-declaration at 12 months (peak V̇O2: from 17.3 to 16.7 to 18.7 mL/min/kg; AT: from 11.8 to 11.2 to 11.6 mL/min/kg). Further, patients with multiple comorbidities at pre-declaration had a significantly lower peak V̇O2 at 3 months (-1.0 mL/min/kg, p = 0.025) and it remained significantly low in those with a slower gait speed at 12 months after lifting the emergency declaration (-2.5 mL/min/kg, p = 0.009). CONCLUSION: The emergency declaration declined the exercise tolerance in patients on phase III CR but improved to pre- declaration levels over time, but more likely declined in patients with multiple comorbidities during pre-declaration and those with low-gait speeds were less likely to improve their declined exercise tolerance.

Segmental extracellular-to-intracellular water resistance ratio and physical function in older adults.

OBJECTIVES: This study aimed to investigate the association between whole-body (WB), arm, and leg extracellular-to-intracellular water resistance (Recw/Ricw) ratios and various physical functions of each segment and muscle mass using segmental multifrequency bioelectrical impedance analysis. METHODS: In total, 988 community-dwelling older adults were included in the analysis. Physical function was assessed using hand grip, 5-repetition sit-to-stand, 5-m habitual walk, Timed Up and Go, and single-leg balance with eyes open tests. Each segmental Recw/Ricw ratio and muscle mass were assessed at 5 and 250 kHz resistances using a segmental multifrequency bioelectrical impedance analysis device. Pearson's correlation between the segmental Recw/Ricw ratio and muscle mass and physical function was calculated, and the difference in correlation coefficients was tested using Bonferroni correction. Multiple linear regression analysis was conducted using physical function as the dependent variable and the segmental Recw/Ricw ratio as the independent variable, adjusting for sex, age, body mass index, and segmental muscle mass. RESULTS: WB and leg Recw/Ricw ratios were significantly positively correlated with good hand grip performance, gait speed, mobility, balance, and standing power (p < 0.05), after adjusting for sex, age, body mass index, and muscle mass. Furthermore, the leg Recw/Ricw ratio was positively associated with lower extremity physical function compared with WB and arm Recw/Ricw ratios and muscle mass (p < 0.01). Conversely, WB muscle mass was more strongly related to grip strength than WB, arm, and leg Recw/Ricw ratios (p < 0.01). CONCLUSIONS: The Recw/Ricw ratio is useful for identifying older adults with worse physical function. The Recw/Ricw ratio allows for easy and timely screening of older adults with worse physical function in clinical settings.

Built Environments and Frailty in Older Adults: The JAGES Longitudinal Study Using Mediation Analysis.

OBJECTIVES: The purpose of this study was to investigate the association between subjective built environment and the onset of frailty in older adults living in the community. In addition, we examined whether daily walking time, depressive symptoms, and social support from neighbors and friends are mediating factors. DESIGN: This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study. SETTING AND PARTICIPANTS: Participants included 38,829 older adults who were not frail recruited from 22 cities and towns. METHODS: The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were 5 items for the subjective built environment. The mediating variables were walking time of at least 30 minutes per day, a Geriatric Depression Scale (GDS) score of at least 5 points, and social support from neighbors and friends. We performed a causal mediation analysis of mediating effects between each built environment and frailty onset. Furthermore, the proportion of mediation was estimated. RESULTS: After 3 years of follow-up, frailty emerged in 2232 adults (6.7%) in 2016. Access to parks and sidewalks, access to fresh food stores, houses or facilities where people feel free to drop in, and fascinating views, or buildings reduced the onset of frailty. Mediators significantly associated with the built environment and onset of frailty were access to parks and sidewalks (walking time: 5.9%, GDS: 22.9%, social support: 5.9%), access to fresh food stores (GDS: 31.9%, social support: 4.0%), hills and steps (GDS: 20.6%), houses or facilities where people feel free to drop in (walking time: 4.0%, GDS 28.0%, social support: 10.4%), and fascinating views, or buildings (walking time: 7.8%, GDS: 42.1%, social support: 12.0%). CONCLUSIONS AND IMPLICATIONS: We found that walking time, depression, and social support were mediating factors in the relationship between built environment and the onset of frailty.

Group leisure activities are associated with a lower risk of dementia than individual leisure activities: A 6-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES).

Participating in group leisure activities may lower the risk of dementia compared with doing leisure activities alone. However, only some studies have examined the differences. In this study, we sought to determine whether the incidence of dementia risk differs according to the implementation status of leisure activities (participation in a group or alone). The association between the implementation status of leisure activities and the risk of dementia was examined using Cox proportional hazards models in the 6-year (2010-2016) cohort data of 50,935 participants (23,533 males and 27,402 females) aged 65 years or older of the Japan Gerontological Evaluation Study. Over six years of follow-up, 5395 respondents (10.6%) developed dementia. After adjusting for potential confounders, such as depression and social support, the implementation status of leisure activities was associated with a lower dementia risk in participants who engaged in group leisure activities (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.73-0.85) and a higher dementia risk in those without leisure activity (HR, 1.30; 95% CI, 1.22-1.39), in comparison with those engaging in leisure activities alone. Engagement in group leisure activities may be associated with a reduced risk of dementia.

Social isolation and subsequent health and well-being in older adults: A longitudinal outcome-wide analysis.

BACKGROUND: Social isolation has become a serious public health issue. However, most previous studies examine the relationship between social isolation and a single outcome. We aimed to conduct holistic assessments to understand the multidimensional impacts of social isolation on health and well-being. METHODS: We used the three-wave data (2013, 2016, and 2019) obtained from the Japan Gerontological Evaluation Study. Our exposure, obtained from the 2016 survey, was the Social Isolation Index (SII) comprising five components: no partner, poor interaction with children, poor interaction with relatives, poor interaction with friends, and no social participation). We assessed 36 health and well-being outcomes across six dimensions obtained from the 2019 survey: physical/cognitive health, health behaviours, mental health, subjective well-being, social isolation, and cognitive social capital. Pre-exposure characteristics and prior outcome levels in 2013 were adjusted. We included 47,318 respondents for 4 outcomes (death, dementia, and functional disability) and 34,187 respondents for 32 other outcomes. The Bonferroni correction was used to correct for multiple tests. RESULTS: The total SII scores were associated with a wide range of health and well-being outcomes across the six dimensions. Specifically, we found a robust association between an SII score of four or greater with mortality (Odds ratio: 1.89; 95% CI: 1.46-2.43). Among the five components of the SII, poor interaction with friends and no social participation showed robust associations with a wide range of health and well-being. We also found some robust evidence regarding effect modification by gender and age in the associations between the components of the SII and health and well-being. CONCLUSIONS: Social isolation, specifically social interaction with friends and social participation, may affect a wide range of health and well-being among older adults.

Does social participation foster social support among the older population in Japan? A three-year follow-up study from the Japan gerontological evaluation study.

•Whether social participation has generated new, healthier social support is unclear.•We prospectively examined whether social participation fosters social support.•Social support was dose-responsive to the number of types of social participation.•Social support was fostered by participating in some type of group at any frequency.•Support to encourage social participation may be effective to enhance social support.