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.

[Relationship between local seniors' longest-held occupation, current work situation, and reasons for working].

Objective　The purpose of this study was to clarify how the type and industry of longest-held occupations correlate with current work situations and reasons for working.Methods　In August 2015, we mailed anonymous, self-administered questionnaires to all 8,075 residents aged 65 and over of a district in Ota Ward, Tokyo, excluding those admitted to institutions. The questionnaire inquired about their basic attributes, current employment status, as well as the type of work and industry of their longest-held occupation. Furthermore, those who were currently employed were asked about their reasons for working. We conducted a multinomial logistic regression analysis with the current employment situation as the dependent variable, and a binary logistic regression analysis with the applicability of individual reasons as the dependent variable.Results　A total of 5,184 questionnaires were returned (response rate: 64.2%), and 5,050 were analyzed. For the longest-held form of work, the most common response was full-time and part-time employment (42.7%), and the most common industry was sales and service (24.2%). Roughly 30% of respondents were currently working, with the most common reason being "For a living," followed by "For my health," "To have a purpose in life (ikigai)," and "To contribute to society and build connections." The industry of the longest-held occupation for those currently working was most often self-employment; executive roles in independent businesses, companies, or organizations for those in full-time positions; and professional jobs for those working part-time. For those not currently working, most had been full-time employees or unemployed. With regard to the longest-held occupations, those currently working and who gave the reason "For a living" were most often owners of independent businesses or self-employed, while those stating "For my health," "To have a purpose in life," and "To contribute to society and build connections" had often been full-time employees, executives at a company or organization, or in administrative or technical positions.Conclusion　For seniors' employment or social participation to go smoothly, we believe a support that emphasizes individuality would be effective, including an emphasis on their longest-held occupation, which is deeply connected to their health conditions and quality of life in old age.

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan.

OBJECTIVE: To examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults. METHODS: Postal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model). RESULTS: Almost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303-0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338-3.470). DISCUSSION: Older adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.

Workplace and community social capital and burnout among professionals of health and welfare services for the seniors: A multilevel analysis in Japan.

OBJECTIVE: Despite the potential of the social capital approach in preventing burnout, there is sparse evidence of its contextual effect. This study aimed to reveal the contextual association of workplace and community social capital on burnout among professionals of health and welfare services for seniors in Japan. METHODS: We collected data from a cross-sectional questionnaire survey for all health and welfare professionals working in Community Comprehensive Support Centers (CCSCs) in the central Tokyo area in 2015. We assessed burnout using the Japanese version of the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalization, and reduced personal accomplishment. We prepared social capital items regarding workplace (the CCSC the participants belonged to) and community (the current catchment area of the CCSC). We aggregated individual responses of workplace and community social capital within each CCSC to create group-level workplace and community social capital indicators. RESULTS: Among the 1771 questionnaires distributed, we analyzed 1110 from 211 CCSCs. Multilevel analysis showed that higher group-level workplace social capital was significantly associated with lower scores of all three subscales after adjusting for covariates. Moreover, we found a significant association between greater group-level community social capital and lower scores of depersonalization and reduced personal accomplishment. CONCLUSION: Working in workplaces and communities with higher social capital is related to lower burnout. The findings suggest that strategies to enhance the social capital of their workplace and community would be beneficial in the prevention of burnout among professionals in the field of health and social welfare.

Working for only financial reasons attenuates the health effects of working beyond retirement age: A 2-year longitudinal study.

AIM: The health benefits of paid employment in late life are understood, but they might vary according to work motives. We examined the health effects of employment among older adults, focusing on motivation. METHODS: We carried out a 2-year longitudinal survey from 2013 (baseline) to 2015 (follow up). Among 7608 older adults, the analysis included 1069 who completed both surveys and were employed at baseline. Work motives were assessed using a questionnaire. Participants were assigned to groups based on their responses: (i) financial reasons; (ii) motivation other than financial reasons; and (iii) both financial and non-financial reasons. Self-rated health, mental health and higher-level functional capacity were evaluated as health outcomes. RESULTS: There were group differences in baseline demographic variables and health status; those with financial reasons had lower socioeconomic status and worse mental health. Multivariable logistic regression analysis showed that compared with older workers with non-financial reasons, those with financial reasons were more likely to decline in self-rated health (OR 1.42; 95% CI 1.00-2.03) and higher-level functional capacity (OR 1.55; 95% CI 1.16-2.07), which was independent of potential covariates, including socioeconomic status. However, no differences were evident between those with only non-financial reasons and those having both financial and non-financial reasons. CONCLUSIONS: We found that the participants who worked only for financial rewards had reduced health benefits through working in old age. A prolonged working life among older workers can contribute to maintaining health and can be enhanced by non-financial reasons, such as finding meaning in life and social contact. Geriatr Gerontol Int 2020; 20: 745-751.

Factors relating to social isolation in urban Japanese older people: A 2-year prospective cohort study.

PURPOSE: We analyzed the data from a 2-year prospective-cohort survey to identify factors relating to new incidences of social isolation and recovery from social isolation in community-dwelling older people. MATERIALS AND METHODS: We conducted a longitudinal study (2013-2015) involving 2657 older residents of Iriarai, Japan. A chi-square test, an independent t-test, and logistic regression analysis with imputed data were conducted to examine categorical data, continuous variables, and factors relating to social isolation, respectively. PRINCIPAL RESULTS: The results suggested that the factors that predicted future social isolation included being a man, being older, living with others, having a decline in mental health, having a lower frequency of going out, and not participating in community groups. On the other hand, being younger, having a higher level of mental health, having a higher frequency of going out, and participating in community groups were identified as factors that predicted participants' recovery from social isolation. MAJOR CONCLUSIONS: Some demographic, mental, and social factors could relate to new incidences of social isolation and recovery from social isolation in community-dwelling older people. As aging is an irreversible phenomenon, and there is a limit to preventing all disorders, either building a safety net or introducing exchange programs to prevent social isolation are important interventions for older people.

Is unwilling volunteering protective for functional decline? The interactive effects of volunteer willingness and engagement on health in a 3-year longitudinal study of Japanese older adults.

AIM: The present study explored the interactive effects of willingness to volunteer and actual volunteer engagement on the maintenance of functional health among older Japanese adults, using data from a 3-year longitudinal study. METHODS: We used data from the 3-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (1997). We examined 676 older adults aged >65 years from the rural Nangai District who were independent in their basic activities of daily living (BADL). A follow-up study was carried out in 2000. We categorized participants into four groups: "willing volunteers," "unwilling volunteers," "willing non-volunteers" and "unwilling non-volunteers." Logistic regression analyses were carried out to evaluate the interactive effects of willingness to volunteer and actual engagement in volunteering at baseline on BADL decline over a 3-year period. RESULTS: During the follow-up period, 6.6% of willing volunteers, 17.4% of unwilling volunteers, 16.3% of willing non-volunteers and 21.0% of unwilling non-volunteers experienced a decline in BADL. Unwilling volunteers (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.29-6.43) and both non-volunteer groups (willing: OR 2.70, 95% CI 1.28-5.72; unwilling: OR 2.48, 95% CI 1.32-4.64) had significantly higher odds of BADL decline than did willing volunteers. When unwilling non-volunteer was set as the reference, the OR of unwilling volunteers became 1.16 (95% CI 0.55-2.49), suggesting that unwilling volunteers had a similar odds of BADL decline as non-volunteers. CONCLUSION: Volunteer activity is effective for preventing BADL decline only for those who willingly engage. Geriatr Gerontol Int 2019; 19: 673-678.

A Community-Wide Intervention Trial for Preventing and Reducing Frailty Among Older Adults Living in Metropolitan Areas: Design and Baseline Survey for a Study Integrating Participatory Action Research With a Cluster Trial.

BACKGROUND: Preventing and reducing frailty is an important challenge for Japan in the next decade, especially in metropolitan areas. We launched a community-wide intervention trial (the Ota Genki Senior Project) in 2016 to develop effective community-based strategies for frailty prevention in metropolitan areas. This report describes the study design and baseline survey. METHODS: This study is a community-wide intervention trial that integrates participatory action research into a cluster non-randomized controlled trial for adults aged 65 years or older living in Ota City, Tokyo. We allocated 3 of 18 districts to an intervention group and the other 15 to a control group. Using a mailed self-administered questionnaire, we conducted a baseline survey of 15,500 residents (8,000 and 7,500 in the intervention and control groups, respectively) from July through August 2016. In addition to socioeconomic status and lifestyle variables, we assessed frailty status (primary outcome) and physical, nutritional, and psychosocial variables (secondary outcomes). Based on the baseline findings, an intervention to improve outcomes will be implemented as participatory action research. Follow-up surveys will be conducted in the same manner as the baseline survey. RESULTS: A total of 11,925 questionnaires were returned (76.9% response rate; 6,105 [76.3%] and 5,820 [77.6%] in the intervention and control groups, respectively), and 11,701 were included in the analysis (mean age, 74.3 [standard deviation, 5.5] years; 48.5% were men). CONCLUSIONS: This study is expected to contribute to development of a prototype of a community-wide frailty prevention strategy, especially in metropolitan areas in Japan. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN000026515).

[The relationship between intra- and inter-generational exchange and mental health among young and older adults].

Objective　The purpose of this study was to examine the relationship between intra- and inter-generational exchange and mental health among young adults aged 25-49 years and older adults aged 65-84 years.Methods　In 2016, a community-based, cross-sectional survey was conducted. A total of 3,334 young adults (valid response rate: 24.6%), and 3,116 older adults (valid response rate: 46.0%) completed the survey and were included in the analysis. Their mental health was evaluated using the World Health Organization-Five Well-Being Index (WHO-5), and those who scored under 13 or scored less than one on any item were considered to have poor mental health. To evaluate the intra- or inter-generational exchange, participants were asked about their frequency of interaction with people aged 20-49 years or aged ≥70, excluding family and co-workers. Young adults who interacted with people aged 20-49 years or older adults who interacted with people ≥70 were classified as "having intra-generational exchange," while young adults who interacted with people ≥70 years or older adults who interacted with people aged 20-49 years were classified as "having intergenerational exchange." Therefore, individuals who interacted with both generations were classified as "having multi-generational exchange," and those who did not interact with any generation were categorized as "no exchange." We conducted a logistic regression analysis that included mental health as a dependent variable, intra- and inter-generational exchange as independent variables, and gender, age, educational attainment, marital status, living situation, subjective economic status, social participation, employment, self-rated health, and Instrumental Activity of Daily Living as covariates.Results　Of the 3,334 young adults, 61.5% were mentally healthy, 51.3% had intra-generational exchange, 21.9% had inter-generational exchange, 16.5% had multi-generational exchange, and 42.7% did not have any exchange. Of the 3,116 older adults, 65.8% were mentally healthy, 67.9% had intra-generational exchange, 34.3% had inter-generational exchange, 29.9% had multi-generational exchange, and 21.1% did not have any exchange. A logistic regression analysis revealed that "having intra-generational exchange" and "having intergenerational exchange" were significantly related to better mental health in both young adults (intra-generational; Odds ratios (OR) 1.19, 95% confidence intervals (CI) 1.10-1.30: inter-generational; OR 1.13, 95% CI 1.03-1.25) and older adults (intra-generational; OR 1.15, 95% CI 1.02-1.29: inter-generational; OR 1.46, 95% CI 1.30-1.65). Therefore, "having multi-generational exchange" was more strongly related to better mental health compared with "only having intra-generational exchange."Conclusion　Among young and older adults, intra- and inter-generational exchange were related to better mental health, and multi-generational exchange showed the strongest relationship with better mental health.

For how many days and what types of group activities should older Japanese adults be involved in to maintain health? A 4-year longitudinal study.

OBJECTIVE: Studies have suggested that frequent participation in social groups contributes to the well-being of older people. The primary aim of this study was to identify the number of days older adults should participate in the activities of social groups to maintain their health for 4 years. This study also aimed to examine whether the effective frequency differs by the type of social group activity. METHOD: We examined a prospective cohort of 1,320 community-dwelling older adults over 65 years of age, who responded to both a baseline and a follow-up mail survey, in a suburban city of Tokyo, Japan. The dependent variable was the change in functional competence during 4 years. Logistic regression analyses were conducted to examine the effects of participation in the activities of the 5 most common social groups among older Japanese on maintaining functional competence. RESULTS: Nine hundred and ninety-four participants (76.5%) maintained their functional competence for 4 years. The results of the logistic regression analyses showed that participating in alumni groups less than once a month and being an inactive member were associated with higher odds of maintaining functional competence, after controlling for socioeconomic, demographic and baseline health status. Additionally, the odds of maintaining functional competence for 4 years increased upon participating in volunteer groups once a month or more. These results were also confirmed using logistic regression analysis, even after adjustment for the effects of participation in other social groups. DISCUSSION: The results indicated the effectiveness of volunteer activities that fulfill a social role in maintaining health. Therefore, older adults should be encouraged to participate in activities of volunteer groups at least once a month. Additionally, older adults can obtain positive health outcomes through less frequent participation in alumni groups, compared with the activities of volunteer groups.

Multiple impacts of an intergenerational program in Japan: Evidence from the Research on Productivity through Intergenerational Sympathy Project.

Compelling evidence supporting the benefits of social engagement in older adults has been increasingly discussed. However, knowledge regarding an intergenerational program is limited. Herein, we provide a targeted review of intergenerational programs by focusing on our novel interventional program, Research on Productivity through Intergenerational Sympathy. The Research on Productivity through Intergenerational Sympathy program is an intergenerational picture-book reading program launched in 2004. Participants were involved a 3-month intensive weekly training seminar comprising classes about book selection, reading techniques and basic knowledge of children's school life. Subsequently, they participated in group activities that involved playing a hand game, and reading picture books to children at kindergartens, elementary schools and public childcare centers, once every 1-2 weeks. The Research on Productivity through Intergenerational Sympathy program has shown improvement of physical and psychological functioning of older adults and healthy upbringing of children. Similarly, Experience Corps - designed to train and place volunteers in participating elementary schools for an academic year during which time they assist teachers - also showed positive effects for older adults' health status and the psychological/academic success of young children in the USA. Health promotion efforts for older adults must support social policy for the creation of meaningful service programs for older adults on a large social scale. As such, an intergenerational program based on the concept of social capital, defined as "features of social organization, such as trust, norms and networks, that can improve the efficacy of society by facilitating coordinated actions," is an effective and sustainable program for health promotion among older adults.

[Developing the checklist for at-risk elderly requiring assistance from comprehensive community care support center].

OBJECTIVES: Area Comprehensive Support Centers play critical roles in identifying those elderly not currently using medical or long-term health care services, offering preventative measures against further health crises and possible isolated death. The purpose of this study was to develop an "At-Risk Elderly Checklist." This checklist can help in identifying those at-risk elderly, allowing people in communities to provide the Area Comprehensive Support Center with information about at-risk elderly. METHODS: As a preliminary step, interviews were conducted with 29 professionals who work for 17 different Area Comprehensive Support Centers located in 4 municipalities around the Tokyo Metropolitan Area. We constructed 23 items based on the findings of this preliminary research and existing tools used in different areas. These items represented distinctive characteristics of elderly who need support from Area Comprehensive Support Centers in order to receive necessary medical and long-term care services. A self-report survey was conducted on 109 professionals of 20 Area Comprehensive Support Centers of Ota-ku, Tokyo in order to examine the content validity of the items. RESULTS: Using factor analysis, we identified 5 factors consisting of 19 items. The first factor consisted of 5 items helping people to identify a serious health crisis from the appearance and condition of the elderly individual's home. The health crisis indicated by these items might require immediate hospitalization. The second factor consisted of 5 items that can help people notice symptoms of dementia through their communication with elderly. The third factor consisted of 4 items useful for assessing health deterioration of the elderly by observing various behaviors. The fourth factor consisted of 3 items that people can use to measure the progress of dementia, including issues with how the elderly dressed themselves. The fifth factor consisted of 2 items that can be used to understand signs of declining health or the progress of dementia by paying attention to the elderly individuals' body odor and personal appearance. From the original 19 items, 14 that were considered the most useful in detecting at-risk elderly were selected based on a frequency distribution. The content validity of 14 items was confirmed by 20 professionals from Area Comprehensive Support Centers in Outa-ku. CONCLUSION: This checklist may be effective in the early detection of elderly at risk of serious health crises and isolated death due to not using necessary medical and long-term care services.