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.

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.

Oral function and cumulative long-term care costs among older Japanese adults: a prospective 6-year follow-up study of long care receipt data.

OBJECTIVES: This study evaluated the relationship between status of oral function and related long-term care service costs. DESIGN: This was a prospective 6-year follow-up study of previous survey data. SETTING: The data were obtained from the Japan Gerontological Evaluation Study conducted between 2010 and 2011. PARTICIPANTS: The participants were functionally independent older adults in 12 municipalities across Japan. INTERVENTIONS: Care service benefit costs were tracked over 6 years using publicly available claims records (n=46 616) to monitor respondents' cumulative care costs. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was the cumulative cost of long-term care insurance services during the follow-up period. We adjusted for the presence or absence of oral function problems, age, sex, physical function and socioeconomic and lifestyle background at the time of the baseline survey. RESULTS: Tobit analysis revealed that, compared with those with no oral function problems, cumulative long-term care service benefit costs for those with one, two or three oral function problems were approximately US$4020, US$4775 and US$82 92, respectively, over 6 years. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. With increase in number of oral function problems, there was a concomitant elevation in the cost of long-term care. CONCLUSIONS: Oral function in older people was associated with cumulative long-term care insurance costs. The oral function of older people should be maintained to reduce future accumulated long-term care insurance costs. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. The cost of long-term care was amplified as oral problems increased.

Suggesting Indicators of Age-Friendly City: Social Participation and Happiness, an Ecological Study from the JAGES.

Ascertaining progress in building age-friendly cities (AFCs) requires community diagnostic indicators. This study examines the relationship between social participation and happiness at the municipal level. The data from the Japan Gerontological Evaluation Study (JAGES) from 2013, 2016, and 2019, comprising 442,079 older people from 289 municipalities, are used. We also employ linear mixed-effects models to evaluate the association between social participation and happiness. In these models, we adjust for seven variables as potential confounders. This study reveals that the higher the social participation, except for neighborhood association, the higher the state of happiness (B = 0.14-0.30). Our study suggests that social participation is useful, as a community diagnostic indicator, for monitoring the progress of building AFCs, developing strategies, and creating evidence.

Types of Sports and Exercise Group Participation and Sociopsychological Health in Older Adults: A 3-Yr Longitudinal Study.

PURPOSE: This study aimed to identify the association between a specific sports type and exercise group participation and longitudinal changes in sociopsychological health among community-dwelling older adults. METHODS: Three years of data from the Japan Gerontological Evaluation Study were used, comprising a total of 33,746 men and 36,799 women age ≥65 yr. To determine the relationship between 20 types of sports and exercise group participation in 2016 (baseline) and changes in depressive symptoms (Geriatric Depression Scale (GDS-15)), self-rated health (4-point scale), subjective well-being (11-point scale), and frequency of laughter (days per month) from 2016 to 2019, we performed linear regression analyses with conducting a multivariate adjustment for potential confounders using an inverse probability weighting method. RESULTS: The mean changes over 3 yr were +0.32 and +0.28 in GDS-15, -0.06 and -0.05 in self-rated health, -0.08 and -0.06 in subjective well-being, and -1.21 and -1.19 in frequency of laughter, in men and women, respectively. Men playing golf in a group were more likely to suppress an increase in the GDS-15 ( B = -0.11, 95% confidence interval, -0.18 to -0.05) and decreases in self-rated health (0.04, 0.02 to 0.06), subjective well-being (0.07, 0.02 to 0.12), and frequency of laughter (0.45, 0.11 to 0.80). Women participating in walking, weight exercises, and hiking groups were more likely to prevent an increase in the GDS-15 (-0.12, -0.19 to -0.04; -0.09, -0.18 to -0.01; and -0.16, -0.30 to -0.03, respectively) and decreases in self-rated health (0.03, 0.01 to 0.05; 0.03, 0.01 to 0.06; and 0.08, 0.04 to 0.12, respectively). CONCLUSIONS: Golf in older men and walking, weight exercises, and hiking in older women could be recommended as an effective program for promoting sociopsychological health among older adults in Japan.

Association between Increasing Social Capital and Decreasing Prevalence of Smoking at the Municipality Level: Repeated Cross-Sectional Study from the JAGES.

As smoking cessation is crucial for both individual and public health, this study aimed to elucidate the association between changes in social capital and in terms of smoking at the level of municipal units in Japan. Using repeated cross-sectional data from the Japan Gerontological Evaluation Study, we analyzed data from adults aged 65 years or older from 69 municipal units that participated in two survey waves. We received valid responses from 91,529 and 86,403 older people in 2013 and 2019, respectively, and aggregated all variables by municipal units. For the dependent variable, we used the units' prevalence of smoking for both years. The independent variables were the percentages of social capital indicators, such as social participation, social cohesion, and reciprocity for each of the 69 municipal units. The mean prevalence of smoking increased from 9.7% in 2013 to 10.2% in 2019. Multiple regression analysis revealed that increases in the percentages of sports group participation, receiving emotional and instrumental social support, and reciprocity were significantly associated with decreased prevalence of smoking, after we adjusted for confounding variables. This study indicates that building social capital might be useful in promoting smoking cessation and that its indicators could be useful in monitoring efforts.

Correlates of engaging in sports and exercise volunteering among older adults in Japan.

This study aimed to identify factors associated with engaging in sports and exercise volunteering among older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), a nationwide mail survey of 20,877 older adults from 60 municipalities. Multilevel mixed-effects logistic regression analysis was used to investigate the correlation between engaging in sports and exercise volunteering and 39 variables classified into five factors: (1) demographic and biological, (2) behavioral, (3) psychological, cognitive, and emotional, (4) social and cultural, and (5) environmental factors. Among the analyzed samples, 1580 (7.6%) participants volunteered a few times/year or more often. Factors that showed positive association with the volunteering were older age, a current drinking habit, excellent self-rated health, high proportion of sports group participants in a living area, low municipal population density, and rich social and cultural features (i.e., social cohesion, support, network, and participation). Meanwhile, those that had a negative association were women, low level of education, deteriorated instrumental activities of daily living, having a past or current smoking habit, poor self-rated health, and depressive symptoms. We clarified the characteristics of the population that is more likely to participate in sports and exercise volunteering as well as those of the population that is less likely to participate and requires support.

Community-level social participation and functional disability among older adults: A JAGES multilevel longitudinal study.

PURPOSE: This study investigates the contextual association between types of community-level social participation and functional disability. METHODS: We used 6-year prospective cohort data from the Japan Gerontological Evaluation Study 2010-2016, a nationwide survey of 35,519 functionally independent older adults (mean age: 73.30 ± 5.91 years, 49.6% females). The incidence of functional disability was obtained from municipal long-term care insurance databases. Social participation was assessed at individual and community levels and was categorized as: volunteer, sports, hobby and neighborhood groups, and senior citizen clubs. We calculated the 95% confidence interval (CI) and the hazard ratio (HR) by applying a three-level multilevel survival analysis. RESULTS: During the 6-year observation period, the onset of functional disability occurred among 3473 adults. A higher prevalence of sports (HR 0.88, 95% CI 0.80 to 0.96) and hobby group participation (HR 0.91, 95% CI 0.87 to 0.96) showed significant contextual relationships with functional disability after adjusting for potential confounders. Among females, community-level neighborhood group participation significantly lowered the incidence of functional disability (HR 0.87, 95% CI 0.76 to 0.998). CONCLUSIONS: We found a beneficial effect of a contextual relationship between community-level sports and hobby group participation and functional disability among older adults. Moreover, females benefited a lot from community-level social participation. We propose that promoting sports and hobby groups in a community may help to prevent functional disability among older adults.

Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan.

BACKGROUND: As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. METHODS: We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1-87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01-1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02-1.13), there was no association in urban areas (HR: 1.03; 0.99-1.06). CONCLUSIONS: Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.

Community social support and onset of dementia in older Japanese individuals: a multilevel analysis using the JAGES cohort data.

OBJECTIVE: Recently, there has been an increase in the number of people with dementia. However, no study has examined the association between community-level social support and the onset of incident dementia using multilevel survival analysis. DESIGN: A prospective cohort study. PARTICIPANTS AND SETTING: We analysed data pertaining to 15 313 (7381 men and 7932 women) community-dwelling adults aged 65 years or older who had not accessed long-term care insurance and were living in Aichi Prefecture (seven municipalities) in Japan. PRIMARY AND SECONDARY OUTCOME MEASURES: The association between community-level social support and onset of incident dementia was examined using the Japan Gerontological Evaluation Study, a prospective cohort study introduced in Japan in 2003. Incident dementia was assessed using Long-term Care Insurance records spanning 3436 days from the baseline survey. RESULTS: During the 10-year follow-up, the onset of incident dementia occurred in 1776 adults. Among older people, a 1% increase in community-level social support (in the form of receiving emotional support) was associated with an approximately 4% reduction in the risk of developing dementia, regardless of socio-demographic variables and health conditions (HR=0.96; 95% CI=0.94 to 0.99). CONCLUSIONS: Receiving community-level social support in the form of emotional support is associated with a lower risk of developing incident dementia.

Watching sports and depressive symptoms among older adults: a cross-sectional study from the JAGES 2019 survey.

The current study investigated the relationship between the frequency of watching sports and depressive symptoms among older adults. This study used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide mail survey of 21,317 older adults. Depressive symptoms were defined as a Geriatric Depression Scale score of ≥ 5. Participants were queried regarding the average frequency at which they watched sports on-site and via TV/Internet over the past year. Among the 21,317 participants, 4559 (21.4%) had depressive symptoms, while 4808 (22.6%) and 16,576 (77.8%) watched sports on-site and via TV/Internet at least once a year, respectively. Older adults who watched sports on-site a few times/year (prevalence ratio, 0.70; 95% confidence interval, 0.65-0.74) or 1-3 times/month (0.66, 0.53-0.82) were less likely to have depressive symptoms compared to non-spectators after adjusting for frequency of playing sports, exercise activities, and other potential confounders. Meanwhile, a dose-response relationship was confirmed for watching via TV/Internet (prevalence ratio of 0.86, 0.79, and 0.71 for a few times/year, 1-3 times/month, and ≥ 1 time/week, respectively). This study suggested that watching sports on-site or via TV/Internet, regardless of whether they regularly engage in sports, may reduce the risk of depressive symptoms among older adults.

Community-Level Sports Group Participation and Health Behaviors Among Older Non-Participants in a Sports Group: A Multilevel Cross-Sectional Study.

This study validates the relationship between community-level sports group participation and the frequency of leaving the house and transtheoretical model stages of behavior change for exercise among older individuals who did not participate in a sports group. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study. The proportion of sports group participants at the community level was calculated using the data from 157,233 older individuals living in 1000 communities. We conducted a multilevel regression analysis to examine the relationship between the proportion of sports group participants and the frequency of leaving the house (1 day/week or less) and the transtheoretical model stages of behavior change for exercise. A statistically significant relationship was observed between a high prevalence of sports group participation and lower risk of homeboundness (odds ratio: 0.94) and high transtheoretical model stages (partial regression coefficient: 0.06) as estimated by 10 percentage points of participation proportion. Older individuals, even those not participating in a sports group, living in a community with a high prevalence of sports group participation are less likely to be homebound; they are highly interested and have numerous opportunities to engage in exercise.

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

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

Accuracy of self-reported weight, height and body mass index among older people in Japan.

AIM: Weight and height are usually self-reported in population-based epidemiological surveys. While the accuracy of self-reports has been extensively studied in younger populations, less is known in older populations. We investigated the accuracy of self-reported weight, height and body mass (BMI) in an older cohort in Japan, where overweight/obesity and underweight coexist. METHODS: We used data from older Japanese adults (≥65 years) participating in the Japan Gerontological Evaluation Study in 2016 to 2017 (7357 men and 9271 women). Self-report data were linked to objective data obtained from clinical examinations. RESULTS: The mean ± standard deviation (SD) age was 74.5 ± 5.8 years, mean ± SD weight, height and BMI were 55.7 ± 10.1 kg, 156.0 ± 8.9 cm and 22.8 ± 3.1, respectively. Results showed high intraclass correlation coefficients for self-reported and measured values (0.97 for weight; 0.96 for height). While weight/height were overestimated among men (weight by 0.096 kg; height by 0.27 cm) and women (weight by 0.18 kg; height by 0.27 cm), BMI tended to be slightly underestimated (-0.034 kg/m2 for men; -0.037 kg/m2 for women). However, the absolute differences between self-reported and measured values were not negligible; people had a higher risk for both under- and overestimation of their BMI category with increasing age. Lower education predicted BMI overestimation, whereas lower income predicted BMI underestimation. CONCLUSIONS: Overall accuracy of self-reported body habitus was higher in this cohort of older Japanese compared with previous reports. Nevertheless, misclassification of BMI due to the misreporting of their weight/height was more common among the oldest-old, as well as those with lower education and income. Geriatr Gerontol Int 2020; 20: 803-810.

Specific types of sports and exercise group participation and socio-psychological health in older people.

Older people who engage in sports and exercise in a group render greater benefits for socio-psychological aspects compared to exercising alone. The aim of this study was to identify the prevalence of specific types of sports and exercise groups and the association with self-rated health, depressive symptoms, and frequency of laughter among community-dwelling older people. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study and analysed 63,465 males and 68,497 females aged ≥65 years. The top three most popular types among males were golf (11.3%), walking (8.4%), and ground golf (6.3%). Among females, the top three were fitness exercises (13.8%), walking (8.3%), and weight exercises (6.2%). After adjusting for potential confounders, engaging in golf with a group was significantly related with excellent self-rated health (prevalence ratio, PR, 1.31 in male and 1.78 in female), low depressive symptoms (PR, 0.70 and 0.71), and a high frequency of laughter (PR, 1.12 and 1.13). Among females, walking displayed a significant relationship with all three characteristics (PR, 1.23, 0.79, and 1.06, respectively). Golf in older males and walking in older females might be the first choice for an effective programme to spread sports and exercise groups within the older Japanese community.

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

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

Neighborhood Walkability in Relation to Knee and Low Back Pain in Older People: A Multilevel Cross-Sectional Study from the JAGES.

Few studies have focused on a relationship between the built environment and musculoskeletal pain. This study aimed to investigate an association between neighborhood walkability and knee and low back pain in older people. Data were derived from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independently living people ≥65 years old. A cross-sectional multilevel analysis was performed, of 22,892 participants in 792 neighborhoods. Neighborhood walkability was assessed by residents' perceptions and population density. Dependent variables were knee and low back pain restricting daily activities within the past year. The prevalence of knee pain was 26.2% and of low back pain 29.3%. After adjusting for sociodemographic covariates, the prevalence ratio (PR) of knee and low back pain was significantly lower in neighborhoods with better access to parks and sidewalks, good access to fresh food stores, and higher population densities. After additionally adjusting for population density, easier walking in neighborhoods without slopes or stairs was significantly inversely correlated with knee pain (PR 0.91, 95% confidence interval 0.85-0.99). Neighborhoods with walkability enhanced by good access to parks and sidewalks and fresh food stores, easy walking without slopes or stairs, and high population densities, had lower prevalences of knee and low back pain among older people. Further studies should examine environmental determinants of pain.