Comparison of Three Diagnostic Definitions of Metabolic Syndrome and Estimation of Its Prevalence in Mongolia.

We sought to estimate the prevalence of metabolic syndrome (MS) in the urban population of Mongolia and suggest a preferred definition. This cross-sectional study comprised 2076 representative samples, which were randomly selected to provide blood samples. MS was defined by the National Cholesterol Education Program's Adults Treatment Panel III (NCEP ATP III), the International Diabetes Federation (IDF), and the Joint Interim Statement (JIS). The Cohen's kappa coefficient (κ) was analyzed to determine the agreement between the individual MS components using the three definitions. The prevalence of MS in the 2076 samples was 19.4% by NCEP ATP III, 23.6% by IDF, and 25.4% by JIS criteria. For men, moderate agreement was found between the NCEP ATP III and waist circumference (WC) (κ = 0.42), and between the JIS and fasting blood glucose (FBG) (κ = 0.44) and triglycerides (TG) (κ = 0.46). For women, moderate agreement was found between the NCEP ATP III and high-density lipoprotein cholesterol (HDL-C) (κ = 0.43), and between the JIS and HDL-C (κ = 0.43). MS is highly prevalent in the Mongolian urban population. The JIS definition is recommended as the provisional definition.

Maternal heated tobacco product use during pregnancy and allergy in offspring.

BACKGROUND: Little is known about the association between maternal use of heated tobacco products (HTPs) during pregnancy and the onset of allergy among offspring. This study aimed to determine whether maternal HTP smoking is associated with allergy in their offspring and to evaluate the potential dose-response association. METHODS: In this web-based, cross-sectional survey conducted in July and August 2021 in Japan, we investigated 5688 pairs of postpartum women and infants (<3 years). Clinical diagnoses of infant asthma, rhinitis, conjunctivitis, or atopic dermatitis were reported. Using multilevel Poisson regression, we estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) of allergy in infants with HTP smoking categories cross-classified by pregnancy periods, and adjusted for potential covariates including maternal cigarette smoking and partner's smoking status. Non-smokers served as the reference group. RESULTS: In total, 2.4% women smoked HTPs during pregnancy. Allergy occurred in 7.8% of the infants. The prevalence of allergy increased among the offspring of current HTP smokers during pregnancy at 15.2% (PR = 1.98, 95% CI 1.28-3.05); this association was the most pronounced during the first trimester but attenuated before pregnancy and postpartum. Dose-response associations were observed, for example a one-unit increase in daily maternal HTP use during pregnancy was associated with a 5% increase in allergy onset. Sub-group analyses excluding cigarette smokers during pregnancy and sensitivity analyses using the International Study of Asthma and Allergies in Childhood questionnaire showed a similar pattern. CONCLUSIONS: Maternal HTP smoking during pregnancy is associated with allergy in the offspring.

Functional capacity in community-dwelling older adults maintained by a higher friend network than family network: implications from a two-year longitudinal study.

OBJECTIVE: Maintaining a level of functional capacity is essential for healthy aging. In this research, the association between the change in the level of functional capacity and social network typology was explored over a two-year period. Participants were recruited from a community-based cohort study within Kashiwa City, Japan, and data from the years 2016 and 2018 were used. Cognitive functions, functional capacity, and social network typology were assessed using the Mini-Mental State Examination, the Japan Science and Technology Agency Index of Competence, and the Lubben Social Network Scale, respectively. Binomial logistic regression analysis was then conducted to evaluate the association of individuals' personal network and their functional capacity. RESULTS: Results showed that, when compared to the group with both a high family and friend network, the group of community-dwelling older adults with both a low family and friend network (OR: 0.58, 95% CI: 0.34-1.00), and the group with a high family but low friend network demonstrated a lower functional capacity (OR:0.47, 95% CI: 0.26-0.85). Active social participation, facilitated by a friend network, could be a contributing factor to the maintenance of functional capacity.

Neighborhood Association, Peer Communication, and Self-Assistance Behaviors Against Disaster Among Individuals With Spinal Cord Injury.

OBJECTIVE: Individuals with spinal cord injuries (SCIs) are vulnerable in case of disaster, and it is unknown how they can prepare themselves for such events. This study explored factors associated with self-assistance behaviors against disasters. METHODS: An internet-based cross-sectional survey was conducted in Japan. The participants were 70 individuals with SCI in a self-help group in Japan. Self-assistance behaviors against disaster were defined in terms of personal network, escape, information, essential items, disaster drill participation, and list registration. After identifying significant variables through binary analyses, logistic regression analysis was conducted to adjust for age and sex. RESULTS: Neighborhood association and peer communication significantly predicted list registration (AOR:2.97; 95% CI:1.05 - 8.40; P = 0.04; AOR:2.79, 95% CI:1.00-7.74, P = 0.05). However, no significant factor was found in relation to other self-assistance behaviors against disasters. CONCLUSION: Belonging to a neighborhood association and having communication with peers could help individuals with SCI register on a list for assistance during disaster. To promote self-assistance behaviors against disasters, access to neighborhood associations, and opportunities for peer communication should be increased.

Lower urinary tract symptoms and functional ability in older adults: a community-based cross-sectional study.

OBJECTIVES: Functional ability, or the ability to live actively in older age, is essential for healthy ageing. This study assessed the association between the five types of lower urinary tract symptoms (LUTS) and functional ability among community-dwelling older adults (≥65 years old). DESIGN: A cross-sectional study. SETTING: Community-dwelling older adults (≥65 years old) randomly selected from the basic resident register of Kashiwa city as part of the Kashiwa study. PARTICIPANTS: The study included 916 community-dwelling older adults (481 male participants) in Japan. OUTCOME MEASURES: A self-administered questionnaire was used to collect data regarding LUTS, which included frequency, nocturia, urgency, urinary incontinence and overactive bladder (OAB). Functional ability was measured using the Japan Science and Technology Agency Index of Competence. Sex-stratified logistic regression analyses were conducted, adjusting age, obesity, alcohol consumption, polypharmacy and comorbidities. RESULTS: Male participants experienced symptoms of frequency, nocturia, urgency, urinary incontinence and OAB at rates of 68.0%, 89.0%, 16.0%, 3.7% and 4.3%, respectively. Female participants experienced these symptoms at rates of 68.3%, 80.0%, 11.0%, 7.4% and 8.5%, respectively. Among male participants, lower functional ability was only associated with nocturia (≥3 times/night) (adjusted OR (AOR): 1.71, 95% CI 1.05 to 2.79). Contrarily, lower functional ability among female participants was significantly associated with frequency (AOR: 1.61, 95% CI 1.04 to 2.49), urgency (AOR: 2.06, 95% CI 1.08 to 3.95) and OAB (AOR: 2.43, 95% CI 1.15 to 5.11). CONCLUSION: The different associations between LUTS and functional ability by sex might be related to differences in the effect of comorbidities and physical fatigue. Our results help clarify the multifaceted effects of LUTS in old age, the need for early detection and treatment of LUTS, and the importance of maintaining functional ability.

Characteristics of patients who received helicopter emergency medical services in Japan from 2012 to 2019: a retrospective analysis of data from Tochigi Prefecture.

BACKGROUND: Helicopter Emergency Medical Services (HEMS) has been in operation in Japan since 2001, allowing patients almost anywhere in the nation to receive on-scene emergency treatment from physicians. However, there is insufficient literature on the characteristics of the patients who use Japanese HEMS. Thus, this study aimed to investigate the overall characteristics of patients receiving HEMS care within a single prefecture in Japan. METHODS: We retrospectively analyzed the data of 5163 patients-in Tochigi Prefecture-who received HEMS care from 2012 to 2019. Descriptive statistics were used to analyze the following aspects of care: diagnosis, severity, background characteristics, geographical and environmental variables, immediate pre-hospital intervention, transportation type, and short-term clinical outcomes. RESULTS: Among 7370 HEMS requests received during the study period, treatment was provided to 5163 patients (1.8 cases per day; 3489 men [67.6%]). Nearly 55% (n = 2856) of patients were aged above 60 years. Age peaks were observed at 0-9 years and 60-69 years. The median distance from the base hospital to the site was 26.7 km. The age-standardized rate of HEMS treatment was 30.3 patients per 100,000 people. Cases of trauma and cardiovascular diseases were the most common (65.3%). Most individuals aged 0-9 years and 60-69 years had neurological disease (seizures accounted for 80.5% of this group) and cardiovascular disease, respectively. The number of patients was similar across all four seasons. After immediate pre-hospital intervention, 81.6% of patients receiving HEMS care were transferred by the helicopter ambulance (53.4% and 28.2% to the base hospital and to other hospitals, respectively). Overall, 56.6% of patients receiving HEMS care were transferred to the base hospital, and the short-term recovery rate was above 75%. Intravenous drip and oxygen administration were the most common pre-hospital interventions (93.1% and 72.7%, respectively). CONCLUSIONS: This study is the first to describe the overall characteristics of HEMS patients using comprehensive data of all HEMS patients in one prefecture in Japan. Further research using both local- and national-level data is needed to accelerate the understanding of the benefits of HEMS.

Characteristics of Emergency Neurological Patients Who Were Transported by Helicopter Emergency Medical Services in Tochigi, Japan.

In Japan, reports on the association of individual characteristics, and geographical distance and time with clinical outcomes for neurological emergencies involving helicopter emergency medical services (HEMS) are scarce. Using Tochigi HEMS data (2010-2018), we assessed the characteristics of 1,170 emergency neurological patients (e.g., stroke, neurotrauma, and seizure) at the base hospital, which covered 58% of all HEMS patients in the prefecture. After initial treatment in the emergency room, emergency physicians confirmed the clinical outcomes of each patient compared to those at the incident sites (recovery/non-recovery). We calculated the geographic distance from the base hospital to each incident site, and estimated and adjusted odds ratios (aOR) and 95% confidence intervals (CI) for non-recovery against distance. The mean distance between the incident site and base hospital was 22.0 ± 11.7 km, and 77.4% of patients recovered following initial treatment. Two peak age groups were observed among emergency neurological diseases, including seizures in patients who were aged < 5 years and stroke and neurotrauma in patients who were aged 70-80 years. The percentages of stroke, traumatic head and brain injury, and seizure were 35.8%, 29.2%, and 22.8%, respectively. The incidence of stroke (aOR = 11.8, 95% CI 6.86-20.3) and neurotrauma (aOR = 4.86, 95% CI 2.78-8.51) independently predicted a poor prognosis. However, no significant association was observed with the distance from the base hospital. Therefore, in the Tochigi prefecture, geographical disparities may not affect the short-term prognosis of patients with neurological emergencies who were transported by HEMS.

Occupational difference in use of heated tobacco products: a cross-sectional analysis of retail workers in Japan.

OBJECTIVE: Although heated tobacco products (HTPs) have become popular worldwide, research on occupational differences in smoking HTPs remains scarce. We aimed to examine the prevalence of smoking HTPs among a working population in Japan. SETTING, DESIGN AND PARTICIPANTS: In 2018, we conducted a cross-sectional study comprised of 7714 retail business workers in the service industry in Japan. PRIMARY AND SECONDARY OUTCOME MEASURES: For the definition of smoking HTPs, we identified current HTP smokers who only smoked HTPs, using five mutual categories of current smoking status (never, former, HTPs only, combustible cigarettes only and dual smokers who smoked both combustible cigarettes and HTPs). Occupational classes were classified into office workers (eg, upper non-manual workers) and other workers. ORs and 95% CIs of office workers were estimated for HTP usage, adjusted for age, sex, employment type and cigarette smoking-related health knowledge. RESULTS: The overall prevalence of smoking HTPs was 3.0% (male 5.0%, female 2.2%). The prevalence of HTP smokers differed across occupational classes (5.6% in office workers vs 2.5% in others; p<0.05). Compared with other workers, the adjusted odds of office workers for smoking HTPs remained elevated (OR: 1.97, 95% CI: 1.40 to 2.77). Sensitivity analyses with workers of all smoking status showed the same pattern. When stratified by sex, the occupational difference only remained significant in male workers. CONCLUSIONS: We found a positive occupational difference in smoking HTPs, particularly among male workers in the retail sector in Japan. National tobacco control should explicitly address this occupational gap and further encourage individuals to quit smoking.

A comparison of sarcopenia prevalence between former Tokyo 1964 Olympic athletes and general community-dwelling older adults.

BACKGROUND: This study aimed to determine how increased muscle mass and athletic performance in adolescence contribute to the prevention of sarcopenia in old age, accounting for the type of sport and the continuation of exercise habits. We compared the prevalence of sarcopenia, its components (low appendicular skeletal muscle mass, low muscle strength, and low physical function), and musculoskeletal pain using data from two cohorts: former athletes who competed in the 1964 Tokyo Olympics and general community-dwelling older adults living in Kashiwa City, Chiba Prefecture. METHODS: We analysed the data from 101 former Olympic athletes (mean age ± SD: 75.0 ± 4.4 years; 26% female) and 1529 general community-dwelling older adults (74.1 ± 5.5 years; 49% women). We assessed sarcopenia (defined by the Asian Working Group for Sarcopenia revised in 2019) and musculoskeletal pain and considered potential confounding factors such as demographic characteristics, for example, sex and exercise habits. RESULTS: The prevalence of sarcopenia was significantly lower in former Olympic athletes than general older adults (odds ratios [OR], 0.49; 95% confidence interval [CI], 0.20-0.94), especially with regard to superior appendicular skeletal muscle mass and muscle strength. This effect was more pronounced in individuals who continued their exercise and in athletes whose sporting discipline was classified as having a high exercise intensity. Conversely, low physical function (OR, 2.60; 95% CI, 1.16-6.07) and musculoskeletal pain (OR, 2.22; 95% CI, 1.24-3.97) were more prevalent in former Olympic athletes and in athletes who competed in sports with physical contact. CONCLUSIONS: We observed a lower prevalence of sarcopenia and superior appendicular skeletal muscle mass and strength in the former Olympic athletes, especially among those that continued their exercise habits and those in sports with high exercise intensity. Conversely, low physical function and higher musculoskeletal pain scores were more prevalent in former Olympic athletes, especially among athletes who competed in sports with physical contact. Our results warrant further promotion of exercise in adolescence and beyond as well as providing safety education, which is required to prevent the development of sarcopenia and musculoskeletal pain in old age.

Impact of Health Literacy on the Progression of Frailty after 4 Years among Community-Dwelling Older Adults.

Health literacy (HL) promotes healthy lifestyle behaviors among older adults, and its relationship with frailty remains unclear. This study examined whether HL is a predictor of frailty progression among community-dwelling older adults. Data from two surveys conducted in 2012 and 2016 involving older residents (mean age, 71.6 ± 4.6 years) of Kashiwa City, Chiba Prefecture, Japan were used. Only healthy individuals without frailty and cognitive impairments participated in the 2012 assessment, where the Kihon Checklist (KCL), HL, and other variables were assessed. Logistic and multiple logistic analyses were used to assess the effects of HL and other factors on frailty between the 'high HL' vs. 'low HL' groups in 2012 and between the 'robust' vs. 'frailty-progressing' groups in 2016. Of the 621 robust participants, 154 (25.4%) had progression of frailty in 2016, which was significantly associated with advanced age, higher KCL score, lower HL, poor mental health, and lack of social support. Furthermore, low HL was a predictor of frailty progression. Low HL may be associated with frailty progression. The obtained results suggest that increased health literacy should be effective in preventing frailty for community-dwelling older residents.

[Oral frailty is associated with food satisfaction in community-dwelling older adults].

AIM: The fact that accumulated reductions in the oral function with aging (i.e. oral frailty) lead to physical frailty has recently received considerable attention, and countermeasures are being promoted, mainly in the field of dentistry. We assessed the relationship between oral frailty and subjective food satisfaction under the hypothesis that oral frailty is also related to psychological problems. METHODS: Participants were attendees of the fourth wave of the Kashiwa cohort study in 2016. We excluded individuals with cognitive impairment and those who had missing values in the main variables. Regarding food satisfaction, "tastiness," "enjoyment," and "amount of food" were evaluated with self-administered questionnaires. Oral conditions were evaluated based on the number of remaining teeth and oral frailty. RESULTS: Of the 940 participants (mean age 76.3±5.1 years; 53% men), 71% responded that their food was "tasty," 96% said it was "enjoyable," 23% said that the amount of food was "large," and 63% said that the amount was "normal." While the number of teeth (20.8±8.5) was not significantly associated with food satisfaction, compared to those without oral frailty, those who had oral frailty were less likely to feel satisfaction with their meals ( "tasty," adjusted odds ratio [95% confidence interval] = 0.49 [0.29-0.83]; "large," 0.36 [0.15-0.84]; "normal," 0.44 [0.22-0.85]). CONCLUSIONS: Our results indicated negative associations between oral frailty and food satisfaction. In addition, the absence of a significant association with the number of teeth suggests that it is necessary to maintain not only the number of teeth but also the comprehensive oral function to support older people's enriched diets.

A qualitative study on the reasons for solitary eating habits of older adults living with family.

Eating alone while living with family members is a risk factor for mental health decline in old age. However, little is known as to why older adults choose to eat alone, even with family present. This study therefore aimed to explore reasons for older adults eating alone despite living with family members, using a qualitative approach. Fifteen people aged 65 years and older (11 men and 4 women) who were eating alone while living with family members were included in the study. These individuals were selected from the participants of the Kashiwa cohort study conducted in 2016. Individual interviews were conducted using an open-ended format. All interviews were recorded and transcribed. The data were further thematically analyzed using a qualitative software package, NVivo 11. We extracted six themes as reasons for eating alone and hypothesized interactions among these themes. The extracted themes were: "age-related changes," "solo-friendly environment," "family structure changes," "time lag for eating," "bad relationships with family members" and "routinization." To assess interactions, the themes were categorized as "background factors," "triggers," and "stabilizers." The aforementioned themes could lead to the development and sustained behavior of eating alone among older adults living with family members. As most themes describe conditions that are likely to remain static, it may not be realistic to encourage such individuals to begin eating with family members. The promotion of meals with neighbors or friends could be effective in alleviating the negative consequences of eating alone.

[The associations of frailty with regular participation in physical, cultural, and community social activities among independent elders in Japan].

Objective　The goal of the study was to assess the relationships of the frequency (more than one time per week) of various activities to frailty among independent elderly people in Japan.Methods　Survey data were collected from 73,341 community-dwelling elders who were not certified as Needing Long-Term Care. Basic checklist survey items developed by the Ministry of Health, Labour and Welfare were used along with exhaustive items on the weekly physical, cultural, community, and volunteer activities of the respondents. The effects of the frequencies of each activity with and without frailty were estimated. The relationship between frailty and pre-frailty was analyzed in a multinomial logistic regression model regarding involvement in activities and controlling for the effects of gender, age, and with non-frailty as a reference category.Results　Data on 49,238 individuals in the study area not certified as Needing Long-Term Care (24,632 males and 24,606 females), corresponding to 67% of all elderly (aged 65 or more years) Japanese people were analyzed. About 65.9% of the respondents reported that they engaged in physical activities, 78.8% reported cultural activities, and 14.9% reported community social activities. The percentages classified as frail and pre-frail were 12.8% and 22.7%, respectively. All of the activities significantly related to frailty. The adjusted odds ratio (95% CI) of frailty among the respondents that engaged in all the types of activity was: 2.19 (1.71, 2.80) among those that reported no physical activities, 1.48 (0.91, 2.43) among those with no cultural activities, and 2.09 (1.80, 2.44) among those with no community social activities. The adjusted odds ratio on frailty for the three groups reporting one type of activity ranged from 5.40 to 6.42, which was statistically significant, and the adjusted odds ratio on the group reporting no activities was 16.41 (14.02, 19.21). These results indicate that the extent of frailty increased as the number of activities decreased.Conclusions　This cross-sectional study found that frailty among elders in Japan was separately associated with participation in cultural activities, social community activities, and physical activities. Frailty was more severe among those with less participation. This result suggests that, for elders who find it difficult to participate in physical activities, engaging in cultural or community social activities might help to prevent or delay frailty.

"Yubi-wakka" (finger-ring) test: A practical self-screening method for sarcopenia, and a predictor of disability and mortality among Japanese community-dwelling older adults.

AIM: We developed a simple self-screening method, the "Yubi-wakka (finger-ring)" test to assess sarcopenia swiftly. This prospective cohort study aimed to examine the validity of this test as a practical method among community-dwelling older adults for identifying sarcopenia, and for predicting disability and mortality. METHODS: We followed 1904 older adults, and analyzed associations between this "Yubi-wakka" test result at baseline in 2012 and sarcopenia at baseline, new-onset sarcopenia followed until 2014, and new-certification for the long-term care insurance and mortality followed until 2016. The "Yubi-wakka" test checks whether the maximum non-dominant calf circumference is bigger than the individual's own finger-ring circumference, which is formed by the thumb and forefinger of both hands. We divided participants into three groups, "bigger," "just fits" and "smaller" based on a comparison between the calf and finger-ring circumference. RESULTS: Of 1904 participants (mean age 72.8 ± 5.4 years), 53% were grouped as "bigger," 33% were in "just fits" and 14% were in "smaller." Relative to "bigger," the test results statistically associated with sarcopenia ("just fits" OR 2.4, 95% CI 1.4-4.1 and "smaller" OR 6.6, 95% CI 3.5-13), by multivariate analyses. The test results also increased the risk of new-onset sarcopenia ("just fits" HR 2.1, 95% CI 1.2-3.8 and "smaller" HR 3.4, 95% CI 1.8-6.4). Furthermore, the "smaller" had 2.0- and 3.2-fold increased risks for needing long-term care insurance services and mortality, respectively. CONCLUSIONS: The "Yubi-wakka" test is an extremely practical method to identify older adults at risk of sarcopenia, disability and mortality. This test might contribute to increased primary prevention for sarcopenia by serving as an early wake-up call for older adults against becoming sarcopenic. Geriatr Gerontol Int 2018; 18: 224-232.

Oral Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly.

Background: Oral health is important for maintaining general health among the elderly. However, a longitudinal association between poor oral health and general health has not been reported. We investigated whether poor oral status can predict physical weakening (physical frailty, sarcopenia, and subsequent disability) and identified the longitudinal impact of the accumulated poor oral health (i.e. oral frailty) on adverse health outcomes, including mortality. Methods: A total of 2,011 elderly individuals (aged ≥ 65 years) participated in the baseline survey of the Kashiwa study in 2012. At baseline, 16 oral status measures and covariates such as demographic characteristics were assessed. As outcomes, physical frailty and sarcopenia were assessed at baseline and at follow-up in 2013 and 2014. Physical independence and survival were assessed from 2012 to 2016 at the time of long-term care certification and time of death. Results: Poor oral status as determined by the number of natural teeth, chewing ability, articulatory oral motor skill, tongue pressure, and subjective difficulties in eating and swallowing significantly predicted future physical weakening (new onsets of physical frailty, sarcopenia, and disability). Oral frailty was defined as co-existing poor status in ≥3 of the six measures. Sixteen per cent of participants had oral frailty at baseline, which was significantly associated with 2.4-, 2.2-, 2.3-, and 2.2-fold increased risk of physical frailty, sarcopenia, disability, and mortality, respectively. Conclusion: Accumulated poor oral status strongly predicted the onset of adverse health outcomes, including mortality among the community-dwelling elderly. Prevention of oral frailty at an earlier stage is essential for healthy aging.

Disaster anxiety and self-assistance behaviours among persons with cervical cord injury in Japan: a qualitative study.

OBJECTIVES: Persons with disabilities, especially those with a severe disability, have a vague anxiety about future disasters; however, the measures of self-assistance for disaster preparedness have not been standardised. The present study aimed to describe disaster-related anxiety and behaviours related to disaster preparedness among persons who have cervical cord injury in Japan. DESIGN: Qualitative study. SETTING: Tokyo Metropolitan area, Japan. PARTICIPANTS: 16 persons with cervical cord injury participated. Inclusion criteria were being 20 years old and older, being diagnosed with cervical cord injury, being able to communicate verbally, having an interest in disaster preparedness, and belonging to a self-help group of persons with cervical cord injury in the Tokyo Metropolitan area. RESULTS: Participants usually had 'anxiety about health management' and it became more serious once they thought about a disaster. We identified three themes in relation to their anxiety: 'storing needed items,' 'staying in a safe place' and 'having reliable caregivers.' We also identified three other themes that were the reasons behind these themes: 'travel experiences,' 'experiences of failure' and 'information from peers.' CONCLUSIONS: To buffer the anxiety about health management in a disaster, it would be important for persons with cervical cord injury to store needed items, stay in a safe place and have reliable caregivers. Various daily experiences, including experiences of failure, would encourage such behaviours.

Psychological resilience and active social participation among older adults with incontinence: a qualitative study.

OBJECTIVES: Incontinence restricts participation in social activities among older adults. However, some older adults participate in social activities despite this condition. This study aimed to describe how older adults with incontinence could be resilient and actively participate in social activities. METHODS: We conducted semi-structured interviews with 11 socially active older adults with incontinence (age 70-90; nine women and two men) at their homes or in private areas of day-service centres in Chiba, Japan. We coded salient narratives by using thematic analysis and extracted themes. Finally, we developed a conceptual model and illustrated the interactions among themes. RESULTS: We identified seven themes that affected active social participation; five of these pertained to psychological characteristics ('motivation to be socially active', 'psychological stress of incontinence', 'desire to interact with others', 'willingness to perform physical exercise', and 'confidence in managing incontinence') and the remaining two pertained to supporting environmental factors ('assistive devices' and 'accessible toilet'). Three psychological themes ('desire to interact with others', 'willingness to perform physical exercise', and 'confidence in managing incontinence') were intertwined with supporting environmental factors and increased the participants' 'motivation to be socially active'. CONCLUSION: Older adults with incontinence can actively participate in the society when they have desire to interact with others, willingness to perform physical exercise, and confidence in managing incontinence. These psychological characteristics are important for being resilient in the face of incontinence and for active social participation.

Sense of coherence as a key to improve homebound status among older adults with urinary incontinence.

AIM: Being homebound is regarded as a negative condition for social participation in Japan. However, little is known about the possibility of psychological resilience to prevent being homebound among older adults with urinary incontinence. The present study aimed to examine the association between sense of coherence as a measure of psychological resilience and being homebound among older adults with urinary incontinence. METHODS: A cross-sectional study was carried out in Chiba, Japan. We trained 95 care managers as interviewers, and they collected the data from 411 community-dwelling frail older adults using a pretested structured questionnaire. Logistic regression analysis was run to identify factors associated with being homebound among the participants with urinary incontinence. RESULTS: Of the participants, 158 (38.4%) had urinary incontinence. Among the participants with urinary incontinence, 52 (32.9%) were homebound. As a result of logistic regression analysis adjusting for age, sex, living status, hobby, types of prevalent diseases, walking ability, perceived social support and subjective social capital, lower meaningfulness in their lives, which is a component of a sense of coherence, remained positively associated with being homebound (adjusted odds ratio 0.79, 95% confidence interval 0.65-0.96). CONCLUSIONS: Being homebound is less prevalent among those who feel challenges, or worthy of investment or engagement in daily life. By improving a sense of meaningfulness, homebound status might be improved among older adults with urinary incontinence. To encourage active social participation of the target population, their psychological resilience (particularly meaningfulness) should be addressed more.

Social capital and life satisfaction: a cross-sectional study on persons with musculoskeletal impairments in Hanoi, Vietnam.

BACKGROUND: Social capital has been recognized as a major social determinant of health, but less attention has been given to social capital of persons with musculoskeletal impairments. The present study aimed to explore the associations between social capital and life satisfaction of persons with musculoskeletal impairments in Hanoi, Vietnam. METHODS: A cross-sectional study was conducted in Hanoi, Vietnam. From June to July 2008, we collected data from 136 persons with musculoskeletal impairments who belonged to disabled people's groups. Social capital was measured using a short version of the Adapted Social Capital Assessment Tool that included group membership, support from groups, support from individuals, citizenship activities, and cognitive social capital. Life satisfaction was measured using the Satisfaction with Life Scale. As possible confounding factors, we measured socio-economic factors and disability-related factors such as activities of daily living. RESULTS: After controlling for confounding effects, group membership remained significantly associated with the level of life satisfaction reported by the persons with musculoskeletal impairments. In particular, being an active member of two or more groups was associated with higher life satisfaction. In contrast, other components of social capital such as citizenship activities and cognitive social capital were not significant in the multiple regression analysis of this study. CONCLUSIONS: The findings suggest the importance of considering an active participation in multiple groups toward the enhancement of the life satisfaction among persons with musculoskeletal impairments. To encourage persons with musculoskeletal impairments to have multiple active memberships, their access to groups should be facilitated and enhanced.