RESUMO
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.
Assuntos
Doenças Cardiovasculares , Neoplasias , Esportes , Humanos , Doenças Cardiovasculares/mortalidade , Neoplasias/mortalidade , Estudos Longitudinais , Masculino , Feminino , Idoso , Japão/epidemiologia , Idoso de 80 Anos ou mais , Causas de Morte , Fatores de Risco , Modelos de Riscos ProporcionaisRESUMO
OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. RESULTS: A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline. CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.
RESUMO
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.
Assuntos
Demência , Comportamento Sedentário , Humanos , Idoso , Estudos de Coortes , Japão/epidemiologia , Exercício Físico , Demência/epidemiologia , AcelerometriaRESUMO
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.
Assuntos
Depressão , Classe Social , Masculino , Feminino , Humanos , Idoso , Estudos Longitudinais , Depressão/epidemiologia , Depressão/diagnóstico , Japão/epidemiologia , Fatores SocioeconômicosRESUMO
ObjectivesãThe Ministry of Land, Infrastructure, Transport and Tourism is promoting the introduction of green slow mobility (GSM) vehicles (can drive up to 20 km/h on public roads) for mobility assistance and potential long-term care prevention. We identified four key factors to pinpoint the challenges and enhance opportunities for introducing GSM; GSM's operational achievements, a comparison of the characteristics of GSM users and non-users, purpose for using GSM, and observation of GSM's contribution to long-term care prevention among older adults.MethodsãA pilot GSM study was conducted in Ikeda City, Osaka Prefecture, from October to December 2022. The service included three routes, operating six times daily on a fixed schedule, and was provided by 10 volunteer drivers. Passengers signaled for boarding, and service details were provided through leaflets. A self-administered mail survey was conducted before and after the demonstration test with 674 respondents to the post-questionnaire, and 502 respondents were asked at both time points about issues related to the service, user characteristics, and care prevention. To assess care prevention, we examined the percentage of favorable changes triggered by GSM based on "opportunities to go out," "personal and behavioral aspects," "social relations," and "psychological aspects." Additionally, we examined whether the health indices in the post-hoc survey were better among GSM users than non-users.ResultsãOf the 223 scheduled GSM services, 214 (96.0%) were operated by 10 volunteers driving an average of 3.1 (SD 2.4) times weekly (0-11 times), indicating an uneven distribution of driving responsibilities. Among the users, 65 (9.6%) were more engaged in community activities and emotional support than non-users. The main purposes for using GSM services were shopping and medical visits, with approximately 70% of users finding it easier to go out owing to these services. The percentage of favorable changes were noted in 3.1-26.2% and 0.2-1.5% of users and non-users, respectively. In the post-test survey, users showed higher independence on the instrumental self-maintenance subscale than non-users.ConclusionãGSM facilitates outings among older adults and may reduce the need for potential long-term care. However, a system is required to ensure that the service burden does not decrease even for a few driving volunteers. Additionally, GSM users are often socially active. Thus, strategies to increase service awareness among less active individuals should be developed.
RESUMO
ObjectivesãThis study aimed to examine the cut-off point of the Risk Assessment Scale (RAS) for predicting the 9-year risk of functional disability among older Japanese adults.MethodsãThis prospective, 9-year follow-up study used data from the Sasaguri Genkimon Study in Fukuoka. Of the 2,629 older adults who did not have functional disabilities and participated in the baseline survey in 2011, 2,254 with complete data were included in the analysis. The RAS was assessed using a questionnaire that showed good predictive and external validity for the 3-year risk of functional disability. The outcome was the incidence of functional disability during follow-up, which was defined as a new certification for the need for support or care. The cut-off point of the RAS was estimated as the point indicating the maximum χ2 value of the log-rank test. The predictive validity of the RAS for functional disability was examined using C-statistics for the total score, and sensitivity and specificity for the cut-off point, respectively. Participants were then categorized into two groups according to the cut-off point (high-score and low-score groups). Hazard ratio (HR) and 95% confidence interval (95% CI) of the 9-year risk of functional disability for the high-score group compared with the low-score group were calculated using the Cox proportional hazard model. In the multivariate model, HR was adjusted for living alone, education, economic status, drinking, smoking, and multimorbidity.ResultsãNew functional disability was certified in 647 participants (28.7%) during a median follow-up period of 8.75 years. The cut-off point for functional disability was 13/14. The C-statistic was 0.774, and the sensitivity and specificity were 0.726 and 0.712, respectively. Compared to the low-score group (0-13 points), the HR (95% CI) of the high-score group (≥ 14 points) for incident functional disability in 9 years was 5.50 (4.62-6.54) in the crude model, and 4.81 (4.00-5.78) in the multivariate model (P<.001).ConclusionãThis study, with its long follow-up period of 9 years, demonstrated that the 13/14 cut-off point of the RAS is suitable for the long-term assessment of functional disability risk. Our results suggest the possibility of using the 13/14 cut-off point of the RAS as a promising tool to grasp the risk of functional disability over a longer time frame, highlighting the potential for early prevention and intervention.
RESUMO
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.
Assuntos
Apatia , Exercício Físico , Vida Independente , Humanos , Idoso , Feminino , Masculino , Estudos Longitudinais , Idoso de 80 Anos ou maisRESUMO
[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.
RESUMO
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.
Assuntos
Demência , Atividades de Lazer , Masculino , Feminino , Humanos , Estudos Longitudinais , Japão/epidemiologia , Risco , Demência/epidemiologia , Demência/prevenção & controleRESUMO
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.
Assuntos
Felicidade , Ambiente Domiciliar , Masculino , Feminino , Humanos , Idoso , Estudos Longitudinais , Japão/epidemiologia , Participação SocialRESUMO
ObjectiveãMaintaining or increasing walking provides several health benefits to older adults. However, the mid-term evaluation of Health Japan 21 [second term] showed that older adults' daily steps did not meet the goal. Therefore, this study emphasized primordial prevention, which is different from previous preventive approaches and focuses on the relationship between the built environment and physical activities, including daily steps. This study investigated the relationship between changes in the number of food stores and walking time.MethodsãThis longitudinal study utilized the self-administered mail survey data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Older adults aged ≥65 years and residing in 27 independent municipalities were recruited. The dependent variable was a change in the walking time at two-time points (increase or not). Our explanatory variable was the change in the number of food stores at two-time points, reported on a 5-point scale, including no store (reference), increased stores, store available, decreased stores, and I don't know. Equivalently, it was defined as the self-reported change in the number of food stores (stores that sell meats, fish, fruits, and vegetables) within the walking distance of participants' homes (within ï½1 km) from 2016 to 2019. The covariates included demographic factors, health behavior factors, environmental factors, and health factors in 2016. We used Poisson regression analysis (5% significance level) to calculate the cumulative incidence rate ratio (CIRR) and 95% confidence interval (CI) for an increase in walking time compared to no increase in walking time. The multivariate normal imputation method supplemented missing data of the dependent variable, explanatory variable, and covariates. Additionally, respondents' answer of "other" for the covariates was supplemented.ResultsãThree years later, 13,400 (20.4%) respondents had increased their walking time. Older adults who reported increased number of stores (5,311, 8.1%) had more walking time than those who reported no stores (6,577, 10.0%) (CIRR=1.12; 95% CI: 1.03-1.21).ConclusionãParticipants who reported an increase in the number of fresh food stores within the walking distance had 12% more walking time three years later. A built environment might be used to measure primordial prevention that increases the amount of walking in daily life. Our results may provide evidence for policymakers and stakeholders to consider healthy urban planning.
Assuntos
Características de Residência , Caminhada , Estudos Longitudinais , Japão/epidemiologia , Nível de SaúdeRESUMO
BACKGROUND: Among all physical activities, walking is one of the easiest and most economical activities for older adults' mental and physical health. Although promoting social participation may extend the walking time of older adults, the longitudinal relationship is not well understood. Thus, this study elucidates the relationship between nine types of social participation and change in walking time during a 3-year follow-up of older adults. METHODS: We conducted a 3-year community-based longitudinal study of independent older adults in Japan. From the 2016 and 2019 surveys, we extracted 57,042 individuals. We performed multiple regression analyses, estimating associations between change in walking time after three years and nine types of social participation in 2016: volunteer, sports, hobby, senior, neighborhood, learning, health, skills, and paid work. We conducted subgroup analysis stratified by walking time in 2016 (i.e., < 60 or ≥ 60 min/day). RESULTS: The mean (standard deviation) change in walking time for 3 years was - 4.04 (29.4) min/day. After adjusting potential confounders, the significant predictors of increasing or maintaining walking time (min/day) were participation in paid work (+ 3.02) in the < 60 min/day subgroup; and volunteer (+ 2.15), sports (+ 2.89), hobby (+ 1.71), senior (+ 1.27), neighborhood (+ 1.70), learning (+ 1.65), health (+ 1.74), and skills (+ 1.95) in the ≥ 60 min/day subgroup compared with non-participants. CONCLUSIONS: Paid work and community activities may be effective for maintaining or increasing walking time among older adults with less (< 60 min/day) and sufficient (≥ 60 min/day) walking time, respectively.
Assuntos
Participação Social , Caminhada , Idoso , Exercício Físico , Humanos , Japão/epidemiologia , Estudos Longitudinais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Relative age effect is defined as a phenomenon where children born early generally perform better than children born later in the same cohort. Physical activity is an important factor that might be influenced by the relative age effect. Socioeconomic factors (e.g., parent's income, education level) are also associated with the adolescent's physical activity. However, no existing study has examined whether socioeconomic factors moderate the relative age effect on the adolescent's physical activity. This study aims to clarify whether and how birth month and socioeconomic factors relate to organized sports and physical activity among adolescents in Japan. METHODS: We conducted a questionnaire survey targeting 21,491 adolescents who live in a widespread neighborhood. We included 8102 adolescents (4087 males and 4015 females: mean age 13.1 ± 1.4) in the analysis. Based on the participants' birth months, we divided them into four groups (April to June, July to September, October to December, January to March). We asked participants to report their organized sports participation. Using the International Physical Activity Questionnaire for Japanese Early Adolescents, we identified their moderate to vigorous physical activity (MVPA). Neighborhood-level socioeconomic factors (areal deprivation, average annual income, education level) were analyzed based on national surveys, such as the population census. We performed multilevel logistic and linear regression analysis for organized sports participation and MVPA, respectively. Moreover, a simple slope analysis was implemented if the interaction between birth month and socioeconomic factor was significant in the multilevel linear regression analysis. RESULTS: Among males, relatively younger adolescents (adolescents who were born later in the same grade) were less likely to participate in organized sports activites (OR=0.90, 95% CI 0.82-0.97, p<0.05), while both males and females engaged in less MVPA (b=-0.54, b=-0.25, p< 0.01, respectively). We observed an interaction between birth month and socioeconomic factors. Among males in low-income neighborhoods, and females in more deprived neighborhoods, relatively younger adolescents engaged in less MVPA. CONCLUSIONS: Socioeconomic factors moderate the relative age effect on adolescents' physical activity. The relative age effect on adolescents' physical activity might be more likely to appear among adolescents from socioeconomically disadvantaged neighborhoods.
Assuntos
Exercício Físico , Características de Residência , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
ObjectivesãSome older adults less interested in exercise may still meet the walking time of 30 minutes or more per day that is required to maintain and improve their health. This study aimed to clarify the characteristics of those who walk for 30 minutes or more per day stratified by the exercise stage of change.MethodsãThis cross-sectional study used a self-administered mail survey conducted by the Japan Gerontological Evaluation Study (JAGES) in 2019. There were 45,939 participants, aged 65 years or above, who were not certified as requiring long-term care and who resided in 62 municipalities in 24 prefectures. The measures included daily walking time, stage of change for exercise (20 minutes or more once a week), and factors related to physical activities (eight demographic and biological; three psychological, cognitive, and emotional; eight behavioral; 40 social and cultural; and three environmental factors). The analysis was stratified into three groups according to the transformation stages: 1) pre-contemplation, 2) contemplation/preparation, and 3) action/maintenance. Poisson regression analysis was conducted with the dependent variable as walking time, the independent variables as physical activity factors, and the covariates as all eight demographic and biological factors.ResultsãOf the 24,146 survey respondents (52.6% response rate), 18,464 were included in the analysis. Surveys with missing items that were important for the analysis and patients who needed care and assistance were excluded. The factors that were significantly associated with walking 30 minutes or more per day only in the pre-contemplation stage, or only in the precontemplation and the contemplation/preparation stages, were three demographic and biological (married; age 80 years or above and non-independence of instrumental activities of daily living were negatively associated), two behavioral (going out at least once a week and watching sports on TV or the Internet), and six social and cultural factors (provision of instrumental support, frequency of meeting with friends more than once a week, participation in the neighborhood association, high reciprocity, reading habits; playing Go was negatively associated).ConclusionsãAmong the demographic and biological factors, and the behavioral, social, and cultural factors, 11 items were found to be associated with walking 30 minutes or more per day only in the pre-contemplation stage, or only in the precontemplation and contemplation/preparation stages. To promote walking even in the lower stages of change, it may be useful to promote exchanges with others, rather than focusing predominantly on physical activities.
Assuntos
Atividades Cotidianas , Exercício Físico , Humanos , Idoso , Estudos Transversais , Japão , Caminhada , Inquéritos e Questionários , Fatores BiológicosRESUMO
ObjectiveãThrough the amendment of the Long-Term Care Insurance Law in 2014, Japan's Ministry of Health, Labour and Welfare established a general long-term care and prevention project centered on "Kayoinoba" to promote participation in social and physical activities for older people, which included environmental approaches for individual health and well-being through community-building. However, reports show that the effectiveness of long-term care and prevention in Kayoinoba across multiple municipalities is limited. The purpose of this study was to verify the effect of participation in Kayoinoba in reducing the risk of functional decline among older people, using data from 24 municipalities of 10 prefectures nationwide.MethodsãThis study examined self-administered mail survey data from the Japan Gerontological Evaluation Study. The participants were older people aged ≥65 years who lived in 24 municipalities of 10 prefectures, in 2013 and 2016. The dependent variable was an increase in total score of ≥5 points on a risk assessment scale predicting incident functional disability ("incident functional disability risk score")(Tsuji et al., 2018), and the explanatory variable was existence of participation in a Kayoinoba program. Nine variables were used as the covariates: educational attainment, equivalent income, depression, smoking, drinking, instrumental activities of daily living, incident functional disability risk score in 2013 (including sex and age), living status (whether the person lived alone), and employment status in 2013. We conducted Poisson regression analysis with stratification of the participants into two groups according to age: young older people and old older people. Sensitivity analysis of the possible increase of ≥3 or 7 points in the incident functional disability risk score was also conducted.ResultsãOf the 3,760 participants in the study, 472 (316 young older people and 156 old older people)[12.6% (11.8%, 14.5%)] participated in Kayoinoba. Compared with those who did not participate in Kayoinoba, the incidence rate ratio (IRR) of increase in risk assessment score was 0.88 (95% confidence interval: 0.65-1.18) for all who did participate, 1.13 (0.80-1.60) in the young older people and 0.54 (0.30-0.96) in the old older people, and was significant in the latter. In addition, similar results were obtained in the sensitivity analysis with the dependent variable as an increase in total score of ≥3 or 7 points on the risk assessment scale predicting incident functional disability.ConclusionsãCompared with those who did not participate in Kayoinoba, functional decline risk was suppressed in those who did participate. The IRR was suppressed 46% in old older people. Promoting participation in Kayoinoba may effectively prevent the need for long-term care in old older people.
Assuntos
Atividades Cotidianas , Geriatria , Idoso , Humanos , Seguro de Assistência de Longo Prazo , Japão/epidemiologia , Participação Social , Inquéritos e QuestionáriosRESUMO
ObjectivesãThis study aimed to investigate whether health inequalities among communities would be reduced by intensively enhancing the "Kayoinoba" program in model communities where many high-risk, older adults live.MethodsãKobe City and the Japan Gerontological Evaluation Study created a mail survey for older adults in 78 communities (community ≈ junior high school district) to conduct community diagnosis. Sixteen communities showed poor values along multiple dimensions of risk and required priority measures. From 2014 to 2019, we designated these 16 communities as model communities. Then, municipal officials and researchers cooperated to support the establishment and management of "Kayoinoba." By using four-waves of mail survey data (in 2011, 2013, 2016, and 2019 with n=8,872, 10,572, 10,063, and 5,759, respectively), secular transitions of nine intermediate outcome indicators (three=social participation, two=social network, and four=social support) and five health outcome indicators (physical function, malnutrition, oral function, cognitive function, and depressive symptoms) were compared between model (n=16) and non-model (n=62) communities via multilevel mixed-effects linear regression analysis.ResultsãIn the 2011 and 2013 surveys, model communities showed poor value compared to the non-model communities in 13 of the 14 indicators. A significant interaction between the year and model/non-model communities was confirmed for four intermediate outcome indicators (sports and hobby group participation, number of friends met, and providing emotional support) and three health outcome indicators (oral function, cognitive function, and depressive symptoms). The differences were reduced or eliminated in the 2016 and 2019 surveys. For example, hobby group participation in 2011 was 29.7% vs. 35.0% in model vs. non-model communities; the difference narrowed to 35.2% vs. 36.1% (P=0.008). Similarly, providing emotional support increased from 83.9% vs. 87.0% to 93.3% vs. 93.3% (P=0.007). Depressive symptoms decreased from 31.4% vs. 27.2% to 18.6% vs. 20.3% (P<0.001).ConclusionsãPromoting community gathering places "Kayoinoba" for six years in communities where many high-risk older adults live may foster social participation, networking, and support and may help reduce health inequalities among communities.
Assuntos
Envelhecimento Saudável , Idoso , Disparidades nos Níveis de Saúde , Humanos , Japão , Participação Social , Apoio Social , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aimed to ascertain the physical-fitness trends among community-dwelling older adults using performance testing. The results of the evaluation conducted during the COVID-19 pandemic were compared to data from the pre-pandemic period. METHODS: A total of 240 community-dwelling older adults who participated in a health checkup program from 2016-2020 underwent the following tests: grip strength (upper limb muscle), single-leg balance with eyes open (static balance), sit-and-reach test (flexibility), timed up-and-go test (TUG, functional mobility), 5 meter habitual walk (walking ability), and hand working with pegboard (hand dexterity). Linear mixed effect models were applied to the hierarchical dataset: repeated data (Level 1), pre-pandemic (2016-2019), pandemic (2019-2020) (Level 2), and individuals (Level 3). Fixed effects and interactions were estimated for the survey year (Level 1), and between the survey year and pre- and post-pandemic (Level 2), with the range of decline set measured in terms of its standardized partial regression coefficient, "B," from 2019-2020. RESULTS: The items for which significant cross-level interactions were identified. In males, the following items showed significant cross-level interactions: sit and reach test (B=-2.56, 95% CI: -4.45--0.66 cm), TUG (+0.39, 0.21-0.56 sec) and 5 meter habitual walk (+0.15, 0.04-0.27 sec). In females items except single-leg balance with eyes open showed significant cross-level interactions: grip strength (-0.58, -1.11--0.05 kg), sit-and-reach test (-3.53, -5.11--1.95 cm), TUG (+0.15, 0.03-0.27 sec), for 5 meter habitual walk (+0.14, 0.04-0.24 sec), and hand working with pegboard (+0.89, 0.28-1.51 sec). CONCLUSION: In both males and females, a significant deterioration in flexibility and mobility movement ability was observed in 2019-2020. In addition, upper limb muscle strength and hand dexterity movement deteriorated in females.
Assuntos
COVID-19 , Humanos , Idoso , Pandemias , Aptidão Física , Vida Independente , CaminhadaRESUMO
AIM: To determine the relationship between performance on the Digital Trail Making Peg test (DTMP) and cognitive function in older adults. METHODS: A total of 203 community-dwelling older adults (mean age: 76.4±5.1 years old) participated in this study. The five-cog test was used to assess the cognitive function. The DTMP measured completion time, number of errors and intra-individual variability for performance variability (coefficient of variation, CV; inter-elemental variability, IEV). Spearman's rank correlation coefficient (ρ) was calculated to examine the association between each variable. In addition, a multiple regression analysis was performed with the cognitive function score as the dependent variable and the DTMP completion time, number of errors, CV, and IEV as the independent variables, with adjusting for the sex, age, years of education, body mass index, medical history, depression, and physical function. RESULTS: The rank correlation coefficients with cognitive function scores were as follows: completion time, ρ = -0.479 (P < 0.01), number of errors, ρ = -0.068 (P = 0.332), CV, ρ = 0.085 (P = 0.225), IEV, ρ = -0.316 (P < 0.01). The results of the multiple regression analysis showed that completion time (ß = -0.566), CV (ß = 0.164), IEV (ß = 2.736) were significantly associated with cognitive function scores. CONCLUSIONS: The shorter the DTMP completion time, the better the overall cognitive function. However, the intra-individual variability of CV and IEV did not show consistent results, with smaller values indicating less intra-individual variability.
Assuntos
Transtornos Cognitivos , Timidina Monofosfato , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Cognição , Humanos , Vida IndependenteRESUMO
BACKGROUND: Social participation has been suggested as a means to prevent depressive symptoms. However, it remains unclear whether a one-time boost suffices or whether participation needs to be sustained over time for long-term prevention. We estimated the impacts of alternative hypothetical interventions in social participation on subsequent depressive symptoms among older adults. METHODS: Data were from a nationwide prospective cohort study of Japanese older adults ≥65 years of age (n = 32,748). We analyzed social participation (1) as a baseline exposure from 2010 (approximating a one-time boost intervention) and (2) as a time-varying exposure from 2010 and 2013 (approximating a sustained intervention). We defined binary depressive symptoms in 2016 using the Geriatric Depression Scale. We used the doubly robust targeted maximum likelihood estimation to address time-dependent confounding. RESULTS: The magnitude of the association between sustained participation and the lower prevalence of depressive symptoms was larger than the association observed for baseline participation only (e.g., prevalence ratio [PR] for participation in any activity = 0.83 [95% confidence interval = 0.79, 0.88] vs. 0.90 [0.87, 0.94]). For activities with a lower proportion of consistent participation over time (e.g., senior clubs), there was little evidence of an association between baseline participation and subsequent depressive symptoms, while an association for sustained participation was evident (e.g., PR for senior clubs = 0.96 [0.90, 1.02] vs. 0.88 [0.79, 0.97]). Participation at baseline but withholding participation in 2013 was not associated with subsequent depressive symptoms. CONCLUSIONS: Sustained social participation may be more strongly associated with fewer depressive symptoms among older adults.
Assuntos
Depressão , Participação Social , Idoso , Depressão/epidemiologia , Humanos , Prevalência , Estudos ProspectivosRESUMO
BACKGROUND: The causal effect of physical activity on reducing dementia risk has been questioned due to the possibility of reverse causation. This study examined the potential causal effects of physical activity on reducing dementia risk using residency in a snowy area as an instrumental variable (IV) representing the physical activity of older adults. METHODS: We used cohort data from the Japan Gerontological Evaluation Study, a longitudinal cohort enrolling people aged 65 or older who were physically and cognitively independent in 2013; study participants were followed for an average of 5.7 years. Participants in the present study included 73,260 individuals living in 19 municipalities in Japan. Physical activity was measured by self-report questionnaires and the incidence of dementia was ascertained by linking participants to the public registries of long-term care insurance. IV estimation was obtained from a piecewise Cox proportional hazard model using a two-stage regression procedure. RESULTS: During the study period, we ascertained 8714 cases (11.9%) of dementia onset. In the IV analysis, we found that the frequency of physical activity per week was negatively associated with dementia risk, though the association weakened over time (Year 1: hazard ratio = 0.53, 95% confidence interval: 0.39-0.74; Year 4: 0.69, 0.53-0.90; Year 6: 0.85, 0.66-1.10). CONCLUSIONS: Our IV analysis indicated a potential causal effect of physical activity on reducing dementia risk that persisted for at least 4 years of follow-up. Thus, we conclude that physical activity should be recommended for older adults to reduce dementia risk.