Effects of intergenerational contact on social capital in community-dwelling adults aged 25-84 years: a non-randomized community-based intervention.

BACKGROUND: Accumulating social capital in urban areas is essential to improve community health. Previous studies suggested that intergenerational contact may be effective for enhancing social capital. However, no study has examined the effect of intergenerational contact on social capital through a population-based evaluation. This study aimed to investigate the effects of a community-based intervention to increase the frequency of intergenerational contact on social capital among adults aged 25-84 years. METHODS: This study used a non-randomized controlled trial design to conduct a community-based intervention (from March 2016 to March 2019). The study area was Tama ward, Kawasaki city, Kanagawa, Japan. The area comprises five districts; one district was assigned as the intervention group and the other four districts as the control group. We provided the intervention to residents in the intervention group. The intervention comprised three phases: Phase 1 was the preparation term (organizing the project committee); Phase 2 was the implementation term (trained volunteer staff members, conducted the intergenerational greeting campaign, and held intergenerational contact events); and Phase 3 was the transition term (surrendering the lead role of the project to the city hall field workers). In the control group, field workers provided public health services as usual. We conducted mail surveys in September 2016 and November 2018 to assess the effects of the intervention on social capital during Phase 2. Eligible participants were randomly selected from community-dwelling adults aged 25-84 years according to age (10,620 control group individuals and 4479 intervention group individuals). We evaluated social trust, norm of reciprocity, and social support as outcome variables. RESULTS: In total, 2518 participants completed both surveys and were analyzed (control group: 1727; intervention group: 791). We found that social trust (coefficient = 0.065; 95% confidence interval [CI]: 0.006, 0.125) and norm of reciprocity (coefficient = 0.084; 95% CI: 0.020, 0.149) positively changed in the intervention group compared with the control group. CONCLUSIONS: This community-based intervention may contribute to sustaining and improving social capital among community-dwelling adults. TRIAL REGISTRATION: UMIN000046769 (UMIN-CTR); first registered on January 28, 2022 (retrospectively registered).

[Actual work situation of second-layer Seikatsu-shien coordinators before and after the first emergency declaration during the COVID-19 pandemic].

Objective　This study aims to understand the status of the resident support activities of second-layer Seikatsu-shien coordinators, who assist in local residents' community development activities, based on long-term care. It observes the effects of these activities, and the presence or absence of relevant instructions from the government or affiliated institutions during and after a state of emergency, such as a lockdown situation. This was examined during the first state of emergency following the COVID-19 crisis, from April to May 2020.Method　In October 2020, a self-administered questionnaire was distributed by mail to 279 second-layer Seikatsu-shien coordinators working in Tokyo's special wards, and 181 responses were collected. The survey focused on the coordinators' activities and activity frequency before the spread of COVID-19, during the state of emergency, and after the activities resumed. Furthermore, the survey questioned whether relevant instructions from the government or affiliated institutions were given during the state of emergency and after the activities resumed. Their details were confirmed in the free comments section.Activity　In creating and revising regional diagnosis tables for the area covered, creating and distributing information magazines and leaflets, etc. included in "understanding social resources and providing information to relevant parties," activity frequency was significantly higher after activities resumed, than before the spread of infection. During the state of emergency, activity frequency was high in the affiliated institution, and only 3.4% of the coordinators visited and spoke to local residents; 91.1% of respondents received instructions from government and affiliated institutions during the state of emergency, and activity frequency was significantly higher when there were instructions; 76.5% received instructions after resuming activities, and activity frequency, such as understanding residents' needs through individual interviews and visits, matching them with services, and supporting the resumption of activity groups was significantly higher when instructions were provided.Conclusion　 After resuming activities, understanding the value of social resources and providing information to the relevant parties was prioritized. During the state of emergency, almost no visits or calls were made to local residents. The frequency of activities to reach out to residents was higher in the presence of instructions, especially after activities resumed. It was suggested that with the rapid spread of a new infectious disease, confusion will likely occur in the field, and having specific instructions will affect the Seikatsu-shien coordinators' activities.

[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.

[School students' greeting behavior and its association with their community attachment and helping behavior].

Objectives　Many local governments and elementary and junior high schools in Japan have conducted a "greeting campaign". This has been done in order to activate communication among local residents, and to instill public spirit and sociability in students' minds. However, few studies have explored the significance of greeting campaigns. The present study investigates greeting in neighborhoods and its relationship with students' spontaneous greeting behavior. The study also seeks to understand the quantity of greeting in daily life and its association with a student's community attachment and helping behavior.Methods　A self-completion questionnaire survey was conducted with 1,346 students studying in the fourth and higher grades at elementary schools, and 1,357 students in the first and second grade at junior high schools. There were 2,692 valid respondents. We performed the following analyses using the data of elementary school students and junior high school students separately. A partial correlation analysis was conducted wherein gender and grade were introduced as control variables. This analysis tested the correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord. A path analysis that tested the relationship between students' greeting behavior, their attachment to residential areas, and helping behavior was also conducted.Results　The results of the partial correlation analysis revealed that there was a positive correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord, regardless of gender and grade. Moreover, the results of the path analysis revealed that the frequency of being greeted was positively associated with community attachment and that the frequency of students' spontaneous greeting behavior was positively associated not only with community attachment but also with helping behavior. The goodness of model fit was high for both the data of elementary school students as well as the data of junior high school students.Conclusion　We found that exchanging greetings with surrounding people in daily life enhanced students' attachment to the community. In particular, we showed that students' spontaneous greeting behavior led to their helping behavior, which supports the significance of recommending greeting at home, school, or in the local community. Since there was a correlation between the frequency of being greeted and the frequency of greeting willingly, we consider that actions of surrounding adults become important to help students acquire spontaneous greeting behavior.

[Awareness of the term "frailty" and its correlates among older adults living in a metropolitan area].

Objectives　This study aimed to examine the awareness of the term "frailty" and its correlates among older adults living in a Japanese metropolitan area.Methods　We used baseline and 2-year follow-up data from a community-wide intervention on preventing frailty in Ota City, Tokyo. In July 2016, we conducted a self-administered questionnaire survey via mail to investigate the lifestyle and health status of 15,500 non-disabled residents aged 65-84 years from all 18 districts. In July 2018, we investigated the awareness of the term "frailty" in the same sample using a different questionnaire, and 10,228 people (4,977 men and 5,251 women) were included in the analyses. In addition, 9,069 people (4,347 men and 4,722 women) who responded to both 2016 and 2018 surveys were analyzed for correlates of awareness of the term "frailty." We categorized the responses "I know the meaning" or "I have heard of it but do not know the meaning" as awareness of the term. Decision tree and multilevel Poisson regression analyses were performed to examine the association of the following with awareness of "frailty": age, marital status, living situation, education, equivalent income, body mass index, number of chronic diseases, alcohol consumption, smoking status, Dietary Variety Score (DVS), and presence or absence of lower back and knee pains, depressive mood, exercise habits, social activity, social isolation, and frailty.Results　Awareness of the term "frailty" was estimated as 20.1% in total (15.5% in men and 24.3% in women). The subgroup with the highest "frailty" awareness was women who exercised, were socially active, and had a DVS of 4 or more (awareness of 36.3%). Significant independent correlates of "frailty" awareness were age (as per year: multivariate-adjusted prevalence ratio=1.03, [95% confidence interval=1.02-1.04]), sex (women: 1.35 [1.21-1.51]), educational attainment (high school: 1.27 [1.11-1.45], higher than junior college/vocational schools: 1.47 [1.28-1.70]), equivalent income (more than 2.5 million yen/year: 1.12 [1.01-1.25]), exercise habits (presence: 1.26 [1.11-1.43]), DVS (6 points or more: 1.37 [1.21-1.55]), social activity (presence: 1.33 [1.20-1.49]), social isolation (presence: 0.75 [0.67-0.85]), and frailty (presence: 0.72 [0.62-0.84]).Conclusions　Although many policies refer to "frailty," the level of awareness of the term among older adults was low. Older adults, especially women, who had higher socioeconomic status, better exercise and dietary habits, and stronger social connections, were significantly more aware of the term. In contrast, individuals who were socially isolated and/or frail did not know the term. Thus, it is crucial to develop specific measures to promote frailty prevention among high-risk individuals.

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).

Co-existence of social isolation and homebound status increase the risk of all-cause mortality.

ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality. METHODS: The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained. RESULTS: In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04-4.63). CONCLUSION: Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.

[Effects of an interprofessional educational program for homecare professionals on building social capital: a trial in an urban area].

Objectives　The importance of social capital in promoting interprofessional collaborations is well known. This study examined the effects of an interprofessional educational program for homecare professionals on building social capital in terms of homecare in an urban area.Methods　The program was conducted at Kita Ward, Tokyo, from July 2014 to January 2015. We used a self-administered questionnaire before and after the program to collect data from homecare professionals in the ward, as well as from those who were interested in providing homecare. Physicians attended a five-day program, while other professionals attended a four-and-a-half-day program. Participants' attitude toward homecare practices was assessed to evaluate their motivation level for the job (i.e., the formation of a practical view of homecare and efficacy to engage in homecare practices). Regarding social capital, we assessed trust and norm of reciprocity for those in the same profession as the respondent (bonding and cognitive social capital) as well as for those in a different profession (bridging and cognitive social capital). Additionally, to professionals other than physicians, we asked about trust and norm of reciprocity regarding physicians (bridging and cognitive social capital) and collaborative conditions with physicians, which included the two sub-domains of cooperation and interaction (bridging and structural social capital). A generalized estimating equation was used to detect the effect size.Results　Of the 54 program participants, 52 (including two physicians) completed both the pre- and post-program questionnaires. Participants' practical view of homecare was formed after the program, although their efficacy for homecare practices was unchanged. With regard to social capital, scores for both trust and norm of reciprocity for the same profession (bonding and cognitive social capital) increased, while those for different professions (bridging and cognitive social capital) were unchanged. Scores for both trust and norm of reciprocity regarding physicians and cooperation with physicians (bridging and cognitive social capital, and bridging and structural social capital) also increased. Finally, trust and norm of reciprocity for the participants improved after the program.Conclusion　The interprofessional educational program for homecare professionals may foster social capital among the participants. The study results imply that this program can be a possible strategy to foster social capital in the field of homecare.

[The influence of types of living alone on 2-year health changes according to elderly adults' marital status: Based on the Comprehensive Regional Studies for Preventing Isolation of the Elderly Who Live in Metropolitan Area (CAPITAL Study)].

Objectives　The aim of this research is to classify elderly adults who live alone by their marital status type and to clarify how those types affect their higher-level functional capacity and mental health with a 2-year follow-up survey.Methods　This research is based on the results from a survey in 2013. The base-line scores were from 757 participants who completed a survey by mail, carried out in B area of A ward, Tokyo, within the jurisdiction of community general support centers, with people who were not at nursing care levels 4 or 5 and who were not residents of welfare facilities. This study analyzed data for 517 of 527 participants, who answered all questions in the 2015 survey and indicated their marital status. This research categorized the respondents into 4 types of marital status: separation, divorce, bereavement, and unmarried groups. This study adopted the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) as the index of higher-level functional capacity, and the WHO-Five Well-Being Index (WHO-5-J) as the mental health index. In the analysis of the causes of 2-year variations in TMIG-IC total scores and WHO-5-J scores, the dependent variable was each variation. This study used an analysis of covariance in which the fixed factors were types of living alone, sex, annual income, and having children who lived separately in the 2013 survey, and the covariance comprised the base-line scores for the dependent variables, age, and chronic diseases in the 2013 survey.Results　With regards to the variation in TMIG-IC total scores, main effects of the types of living alone were observed. The adjusted variation of covariance decreased most in the separation group (-0.95). For the variation in WHO-5-J scores, main effects of the types of living alone were indicated. In the divorce group, the adjusted variation of covariance was significantly higher than for the unmarried group (2.33 vs. -0.55).Conclusion　The results revealed that the types of marital status: separated, divorced, bereaved, and unmarried, affect changes in the higher-level functional capacity and mental health status of elderly adults living alone, 2 years later. Thus, although previously regarded as a single category, types of marital status should be considered in the analysis of elderly adults who live alone.

Assessing competence at a higher level among older adults: development of the Japan Science and Technology Agency Index of Competence (JST-IC).

BACKGROUND AND AIMS: Older adults' ever-improving health and changing lifestyles necessitate the development of a scale that can better measure their competence at a higher level. We developed the Japan Science and Technology Agency Index of Competence (JST-IC) via item analysis and assessed its psychometric properties. METHODS: Participants were 1306 community-dwelling older adults (623 men and 683 women, 74.0 ± 2.8 years old) who completed the 54-item draft JST-IC to determine their level of independence. Three procedures (including item selection, factor analyses, and reliability and validity analyses) were conducted to finalize the JST-IC and evaluate its psychometric properties. RESULTS: The item selection resulted in exclusion of 26 items for the following reasons: (a) 15 because of very high ratios (80% or more) of responders who answered "yes", (b) one because of gender differences (phi coefficient = 0.34), (c) five because of their weak association with the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (Pearson correlation coefficient of 0.30 or smaller), and (d) five because of redundancy of meaning with other items. Through factor analyses, we selected 16 items with a four-factor solution for the final version. JST-IC score exhibited a near-normal distribution and significant gender and age differences, and had moderate correlations with size of social network and level of subjective well-being and strong correlations with TMIG-IC score, physical fitness, and health literacy. CONCLUSIONS: The JST-IC is useful for assessing competence at a higher level in community-dwelling older adults.

[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.

[Community Child-Rearing Support Scale: Applicability across generations and differences in the supportive behaviors among generations].

Objectives　Using the Community Child-Rearing Support Scale (CCRSS), which was developed for older adults, we examined 1) the reliability and validity of the scale for multiple generations, as well as the generational differences in the 2) degree and content of supportive behaviors for child rearing and 3) correlates of the behavior, in conjunction with gender differences.Methods　A mail survey was conducted with residents aged 25-84 years who were randomly selected from two cities in Tokyo and the surrounding areas, and responses were obtained from 8918 residents (response rate: 33%). The respondents were grouped as follows: old-aged (65-84 years), middle-aged (50-64 years), and young-aged (25-49 years). We performed the following analyses by age group and gender: 1) Cronbach's reliability coefficient and a confirmatory factor analysis of the CCRSS, 2) analysis of variance of the total CCRSS scores and scores of the three subscales ("children's security and sound growth," "instrumental support to parents," and "emotional support to parents"), and 3) a multiple regression analysis of the total scores in which various individual characteristics were introduced as explanatory variables.Results　The reliability coefficient was over 0.85 for each age group, and the factor analysis showed good model fitness. Compared to the middle- and young-aged groups, the old-aged group was more likely to provide support for "children's security and sound growth," and equally (for women) or more likely (for men) to provide "emotional support to parents," thereby resulting in the highest total score among the three generations. The mean score of "instrumental support to parents," such as taking care of a child, was the highest for young women, although the score was low overall. Having a child or grandchild under 13 years old and stronger generativity were positively associated with child-rearing support for all age groups; however, the degree of associations varied across the groups. While having a child was strongly associated with support among the young-aged group, the association between support and generativity was stronger for older groups. Moreover, participation in neighborhood associations or volunteer groups and high school or lower education were associated with more support among all age groups, whereas living in rental apartments was associated with less support among the young-aged group.Conclusion　Our findings suggest that the CCRSS can be used for multiple generations and that old people play an important role in child rearing in the community. We found both differences and similarities between generations with respect to the correlates of child-rearing support.

The effect of intergenerational programs on the mental health of elderly adults.

OBJECTIVES: The aim of this study was to clarify the effect of an intergenerational program on elderly persons' symptoms of depressive mood and in improving their sense of coherence, which is an element for successful coping with stressors. METHOD: We evaluated an intervention research project (Research of Productivity by Intergenerational Sympathy [REPRINTS]), in which volunteers >65 years old read picture books to children in a school setting. The intervention group (REPRINTS) was recruited through intensive weekly training seminars for three months. The no-contact control group members were also recreated to participate in health checks and surveys for data collection purposes. Eventually, 26 participants in the intervention group and 54 in the control group were included for data analysis. RESULTS: The age or gender was not significantly different between the intervention and control groups. A two-way repeated-measures ANOVA shows a time × group significant interaction effects. Analyses of the simple main effects showed that sense of meaningfulness significantly increased for members of the intervention group at all terms, with no changes in the control group over time. Multiple mediation analysis revealed that participation in the intergenerational program was associated with a sense of manageability which was also significantly related to depressive mood. CONCLUSION: Intergenerational programs could serve as key health promoters among elderly people by decreasing the risk of social isolation and loneliness due to the greater sense of meaningfulness. However, given our limited sample size, generalizability was restricted and studies with larger cohorts are required to further validate our findings.

[Characteristics of elderly people registering with emergency contacts systems Case study of "elderly monitoring key ring"].

OBJECTIVES: Here we investigated the characteristics of users of an emergency system that tracks elderly people, known as the "elderly monitoring key ring." The relevance of a spreading policy or strategy and the user characteristics were investigated to develop programs conducted by local governments to manage unidentified elderly people with dementia. METHODS: A questionnaire was conducted in July 2013 in a district of the Ota Ward in Tokyo. The questionnaire was administered to residents >65 years of age (N=7,608), of which 5,166 (67.9%) responded. Fully completed responses (N=4,475) were analyzed with binomial logistic regression analysis using "monitoring key rings" as the dependent variable and simultaneously inputted sex, age, living arrangement, social isolation, Instrumental Activities of Daily Living (IADL), and complaints of memory loss as independent variables. Interviews were also conducted in August 2014 of the staff members (N=12) of six community comprehensive support centers in the Ota Ward. RESULTS: The logistic regression analysis results indicated that women used the monitoring key rings 1.64 times more often than men, late elderly used it 4.39 times more often than early elderly, elderly living alone used it 2.14 times more often than elderly not living alone, non-isolated people used it 1.36 times more often than isolated people, IADL non-independent people used it 1.50 times more often than independent people, and people with complaints of memory loss used it 1.37 times more often than those without such complaints. On the other hand, the results of interviews indicated that elderly people living alone, those with worries, and relatively young and healthy elderly people were targets. The main targets of community comprehensive support centers were elderly individuals living alone and early elderly individuals. The utilization rate of elderly people living alone was high; however, that of early elderly people was low. They recognized that people registered with the system tended to have high anxiety, be relatively young and highly independent, and register after learning about the system from their peers or through neighborhood associations. CONCLUSION: Individuals who were female, late elderly, elderly living alone, non-isolated, IADL non-independent, or had complaints of memory loss were most likely to be registered with the key ring. The circumstance of registration which community comprehensive support centers recognize related to the low utilization rate of elderly people who are isolated. In the future, the system should be introduced to socially isolated as well as relatively young elderly people.

Cognitive intervention through a training program for picture book reading in community-dwelling older adults: a randomized controlled trial.

BACKGROUND: Non-pharmacological interventions are expected to be important strategies for reducing the age-adjusted prevalence of senile dementia, considering that complete medical treatment for cognitive decline has not yet been developed. From the viewpoint of long-term continuity of activity, it is necessary to develop various cognitive stimulating programs. The aim of this study is to examine the effectiveness of a cognitive intervention through a training program for picture book reading for community-dwelling older adults. METHODS: Fifty-eight Japanese older participants were divided into the intervention and control groups using simple randomization (n =29 vs 29). In the intervention group, participants took part in a program aimed at learning and mastering methods of picture book reading as a form of cognitive training intervention. The control group listened to lectures about elderly health maintenance. Cognitive tests were conducted individually before and after the programs. RESULTS: The rate of memory retention, computed by dividing Logical Memory delayed recall by immediate recall, showed a significant interaction (p < .05) in analysis of covariance. Simple main effects showed that the rate of memory retention of the intervention group improved after the program completion (p < .05). In the participants with mild cognitive impairment (MCI) examined by Japanese version of the Montreal Cognitive Assessment (MoCA-J) (n =14 vs 15), significant interactions were seen in Trail Making Test-A (p < .01), Trail Making Test-B (p < .05), Kana pick-out test (p < .05) and the Mini-Mental State Examination (p < .05). CONCLUSIONS: The intervention effect was found in delayed verbal memory. This program is also effective for improving attention and executive function in those with MCI. The short-term interventional findings suggest that this program might contribute to preventing a decline in memory and executive function. TRIAL REGISTRATION UMIN-CTR: UMIN000014712 (Date of ICMJE and WHO compliant trial information disclosure: 30 July 2014).

[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.

[Social concern and the present state of intergenerational programs. An analysis of newspaper articles and a survey of organizations].

OBJECTIVES: The objectives of this study were (1) to clarify changes in social concern in intergenerational programs and (2) to determine the current state of and issues affecting intergenerational programs. METHODS: Articles including the words "intergenerational programs" were selected from 3 major Japanese newspapers (Asahi Shimbun, Yomiuri Shimbun, and Mainichi Shimbun) using an online database (399 articles). Content analysis was conducted to check changes in the number and content of articles. A total of 56 cases of intergenerational programs were selected, and a questionnaire survey was conducted with the responsible organization. The problems were classified using cluster analysis. RESULTS: Content analysis revealed that the number of articles relating to this topic increased towards the end of the 1990s, which corresponds with a change in social policy. The questionnaire survey revealed that most of the intergenerational programs were either annual or periodic activities. Furthermore, it was shown that the 4 main issues facing current intergenerational programs were the intergenerational gap, operating problems, activity selection, and lack of participants. CONCLUSION: In summary, social concern regarding the intergenerational programs has increased. However, most intergenerational programs were infrequent and quite time-intensive. Furthermore, the 4 issues mentioned above must be addressed in order to create programs that have wide-ranging benefits for each community. Resolving the problem of compartmentalized administration and appointing local coordinators is necessary to solve these problems.

[Usage conditions and intentions to use monitoring services for the elderly living alone].

OBJECTIVES: To examine the usage conditions and intentions to use monitoring services for independent living by the elderly living alone. METHODS: A cross-sectional survey was conducted using a mail-in, self-administered questionnaire in September 2011. The target population comprised 2,569 elderly people living in Ota Ward, Tokyo. The data of individuals living alone were extracted from the data of all respondents. The response rate was 67.8%. The sample consisted of 1,095 elderly people living alone. Logistic regression analyses were conducted with the usage conditions and intention to use monitoring services set as dependent variables. The factors related to the usage conditions and the intention to use monitoring services were examined. Gender, age, medical histories, existence of children living in the neighborhood, advanced activities of daily living, frequency of going outdoors, social relations, economic status, education, and mental factors were set as independent variables. RESULTS: The monitoring services used to facilitate independent living included the following: emergency communication service = 124 (11.3%), information registration service = 197 (18.0%), monitoring by people = 113 (10.3%), and monitoring by sensor = 51 (4.7%). The number of respondents who indicated their intention to use monitoring services included the following: emergency communication service = 525 (47.9% of the entire sample, 81.4% of non-users), information registration service = 396 (36.2% of the entire sample, 75.1% of non-users), monitoring by people = 357 (32.6% of the entire sample, 60.0% of non-users), monitoring by sensor = 335 (30.6% of the entire sample, 53.1% of non-users). The respondents' ages and medical histories were related to the usage of monitoring services. Their level of anxiety was related to the intention to use monitoring services. CONCLUSION: Usage and intention to use services was greater in conditions in which the elderly needed help to cope with emergent situations than usage and intention to use services that monitored daily life. The elderly who were aware of their need tended to use monitoring services. A future challenge is to expand the use of monitoring services to foster independent living of the elderly living alone.

[Association of confidence in motor function and fear of falling with physical ability in community-dwelling older people].

OBJECTIVE: The objective of this study was to investigate the difference of physical ability depending on the presence or absence of confidence in motor function (CIMF) and fear of falling (FOF) in independently living community-dwelling older adults. METHODS: Participants in this study were 368 community-dwelling older adults (mean age±SD, 72.2±5.7 years) without instrumental activity of daily living (IADL) problems who participated in a comprehensive health check-up. CIMF (existence or non-existence), FOF (existence or non-existence), past medical history, history of a fall within the past year, and self-rated health were assessed by interview. Physical ability [grip strength, one-leg standing (OLS), maximum walking speed (MWS), and timed up & go test (TUG)] was also measured. RESULTS: Our results revealed significantly more older adults with FOF and without CIMF than expected, indicating that CIMF might be a component factor in FOF. Two-way ANOVA adjusted for sex and age showed main effects of the CIMF factor on grip strength, OLS, and TUG, indicating that these physical abilities are reduced in participants without CIMF, regardless of FOF. On the other hand, we found a main effect of the FOF factor on MWS. Logistic regression analysis showed that frequency of going outdoors, self-rated health, arthropathy, and OLS were factors associated with CIMF. CONCLUSIONS: Our results suggest that CIMF is a useful screening tool for older adults with potential problems and evaluation of intervention for health promotion in community-dwelling older adults without IADL problems.