Correlations between Forgetfulness and Social Participation: Community Diagnosing Indicators.

We analyzed the relationships between forgetfulness and social participation, social contact, and social support by municipality to develop community diagnosing indicators. The analysis subjects included 105 municipalities that agreed to provide data for the 2013 Survey of Needs in Spheres of Daily Life in Japan (n = 338,659 people). Forgetfulness as a risk factor for dementia was used as the dependent variable. The variables of social environment factors were (1) social participation, (2) social contact, and (3) social support. The ratio of people responding that they experienced forgetfulness differed among municipalities, with a mean of 19.0% (7.1-35.6%). Higher levels of social participation, social contact, and social support were associated with lower levels of forgetfulness, even after adjusting for age and regional variables. The results of the present study suggest that it is appropriate to use forgetfulness and social participation at least a few times a year in any social activity as community diagnosing indicators. Municipalities could encourage their inhabitants to participate by developing and providing engaging social activities.

Change in Municipality-Level Health-Related Social Capital and Depressive Symptoms: Ecological and 5-Year Repeated Cross-Sectional Study from the JAGES.

Prevalence of depressive symptoms is lower in communities with greater social capital (SC). However, it is unclear whether a prevalence of depressive symptoms will decrease in communities where SC has increased. We investigated the relationship between the changes in municipality-level SC and depressive symptoms by using 5-year repeated cross-sectional data from the Japan Gerontological Evaluation Study. In 2010 and 2016, self-reported questionnaires were mailed to functionally independent residents aged 65 years or older living in 44 municipalities; valid responses were received from 72,718 and 84,211 people in 2010 and 2016, respectively. All scores were aggregated at the municipality level. The dependent variable was the change in the prevalence of depressive symptoms that were diagnosed with a 15-item Geriatric Depression Scale. Independent variables were the score of change in health-related SC indicators, e.g., social participation, social cohesion, and reciprocity. A multiple regression analysis was employed. The average prevalence of depressive symptoms decreased from 28.6% in 2010 to 21.3% in 2016. The increases in the percentages of sports group participation (B, -0.356), and reciprocity scores (B, -0.597) were significantly associated with the decrease in the prevalence of depressive symptoms after adjusting for potential confounding variables. Our findings suggest that community SC might be an intervention for protecting depressive symptoms in municipalities.

Influence of social relationship domains and their combinations on incident dementia: a prospective cohort study.

BACKGROUND: Social relationships consist of mutually related but distinct dimensions. It remains unclear how these domains independently contribute to incident dementia. This large-scale, prospective cohort study examines associations between the social relationship domains as well as their combinations and incident dementia among community-dwelling older adults. METHODS: We analysed data from 13 984 community-dwelling adults aged 65+ without long-term care needs living in Aichi prefecture in Japan. Incident dementia was assessed based on the Long-term Care Insurance records, followed for 3436 days from the baseline survey conducted in 2003. Three social relationships domains (social support, social networks and social activities) were further divided into a total of eight subdomains. A social relationship diversity score was calculated using the social relationship domains which were significantly related to incident dementia. RESULTS: A Cox proportional hazards model showed that being married, exchanging support with family members, having contact with friends, participating in community groups and engaging in paid work were related to a lower likelihood of developing incident dementia, controlling for covariates and other social relationship domains. The diversity scores, ranging from 0 to 5, were linearly associated with incident dementia (p<0.001), and those who scored highest were 46% less likely to develop incident dementia compared with those in the lowest category. CONCLUSIONS: Our findings revealed five social relationship subdomains which were negatively related to incident dementia, suggesting that dementia may potentially be prevented by enhancing these social relationships. Future studies should examine independent pathways between each social relationship domain and incident dementia.

Social interaction and cognitive decline: Results of a 7-year community intervention.

INTRODUCTION: There are few intervention studies that demonstrated linking social participation to lower risk of cognitive decline. We examined prospectively the protective effect of a community intervention program promoting social participation on the incidence of cognitive disability. METHODS: The baseline was established in a survey of community-dwelling older people aged 65 years old or more in July 2006 (2793 respondents, response rate 48.5%). The setting was Taketoyo town in Japan, where municipal authorities launched an intervention that was based on the establishment of community-based centers called "salons," where the town's senior residents could congregate and participate in social activities, ranging from arts and crafts, games, and interactive activities with preschool children. Three salons were established in May 2010, and a total of 10 salons were in operation by 2013. We recorded the frequency of salon participation among survey respondents till 2013 and conducted two follow-up surveys (in 2010 and 2013) to collect information about health status and behaviors. The onset of cognitive disability was followed from May 2007 to January 2014. We used the marginal structural models to evaluate the effect of program. RESULTS: The range of prevalence of cognitive disability was from 0.2% to 2.5% during the observation period. The proportion of respondents who participates to salons increased over time to about 11.7%. The frequency of salon participation was protectively associated with cognitive decline, even after adjusting for time-dependent covariates and attrition (odds ratio = 0.73, 95% confidence interval: 0.54-0.99). DISCUSSION: Our study suggests that operating community salons that encourage social interactions, light physical activity, and cognitive activities among older participants may be effective for preventing cognitive decline. In future studies, we need to understand what sorts of activities (e.g., those involving light physical activity vs. purely intellectual activities) are most effective in maintaining cognitive function.

Evaluation of facilitative factors for preventing cognitive decline: A 3-year cohort study of community intervention.

AIM: We conducted a cohort study to elucidate paticipants' facilitative factors that may help to prevent cognitive decline. METHODS: This study followed 100 participants (average age: 74.1 ± 5.8; 10 men, 90 women) for 3 years; participants had previously been part of the Taketoyo Project (n = 366) in 2007-2011. The end-point was defined as reduced cognitive function in elderly community residents participating in a preventive intervention for dementia. The presence or absence of reduced cognitive function at the end of the third year of intervention was the dependent variable, and all evaluation items were considered explanatory variables. After Fisher's exact test (P < 0.15), stepwise multiple logistic regression analysis (P < 0.05) was performed, and facilitative factors for prevention of cognitive decline were extracted. RESULTS: Items with a significant adjusted odds ratio (OR) based on multiple logistic regression analysis were the three-word delayed recall test (OR: 0.330, 95% confidence interval (CI): 0.142-0.767; P < 0.05), word fluency (OR: 0.565, 95%CI: 0.359-0.891; P < 0.05), frequency of going out (OR: 2.790, 95%CI: 0.803-6.380; P < 0.05) and number of friends with whom they engaged in activities (OR:0.344, 95%CI: 0.127-0.932; P < 0.05). CONCLUSION: Subjects who had maintained a certain level of cognitive function, engaged in activities with friends, and went out frequently at baseline were extracted. In other words, the results suggested that enhancement of social networks and leisure activities prompted by recreational centre participation had a positive effect on maintaining cognitive function. The results also suggest that to improve the effectiveness of preventive interventions for cognitive dysfunction, support for social factors and leisure activities, in addition to cognitive function, may improve the long-term effectiveness of maintaining cognitive function.

Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study.

BACKGROUND: The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias. METHODS: The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called 'community salons', providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument. RESULTS: In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74). CONCLUSIONS: A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.

Analysis of causal relationships by structural equation modeling to determine the factors influencing cognitive function in elderly people in Japan.

The purpose of this study is to identify a potentiality factor that is a preventive factor for decline in cognitive function. Additionally, this study pursues to clarify the causal relationship between the each potential factor and its influence on cognitive function. Subjects were 366 elderly community residents (mean age 73.7 ± 6.4, male 51, female 315) who participated in the Taketoyo Project from 2007 to 2011. Factor analysis was conducted to identify groupings within mental, social, life, physical and cognitive functions. In order to detect clusters of 14 variables, the item scores were subjected to confirmatory factor analysis. We performed Structural Equation Modeling analysis to calculate the standardization coefficient and correlation coefficient for every factor. The cause and effect hypothesis model was used to gather two intervention theory hypotheses for dementia prevention (direct effect, indirect effect) in one system. Finally, we performed another Structural Equation Modeling analysis to calculate the standardization of the cause and effect hypothesis model. Social participation was found to be activated by the improvement of four factors, and in turn, activated "Social participation" acted on cognitive function.

Does social participation improve self-rated health in the older population? A quasi-experimental intervention study.

Social participation has been linked to healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of 'salons' (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on self-rated health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for self-rated health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and self-rated health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in self-rated health over time. The odds ratio of participation in the salon programs for reporting excellent or good self-rated health in 2008 was 2.52 (95% CI 2.27-2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote healthy aging.

[Psychosocial risk factors involved in progressive dementia-associated senility among the elderly residing at home. AGES project--three year cohort longitudinal study].

OBJECTIVES: This study aimed to identify psychosocial risk factors involved in the progression of senility associated with dementia, and clarify activities that may prevent such progression. METHODS: In 2003, as a part of the Aichi Gerontological Evaluation Study Project, a self-completion postal questionnaire survey was conducted among elderly persons aged 65 years or older not under the Certification of Eligibility for Long-Term Care (hereafter, Certification); (response rate: 49.4%). Among the respondents, 9,720 subjects (4,614 males, 5,106 females; average age 72.8 years, range +/- 6.0), whose gender and age were confirmed and who could handle all ADLs independently, were selected for the three-year longitudinal study. The end point of the study was Certification in the second appraisal, through categorization under the ADL Independence Assessment Criteria for the Elderly with Dementia Rank II. Predictive variables used in the study were: health behavior, psychological/ cognitive factors, recreational/social activities, TMIG Index of Competence, and social class. Recreational activities were divided into eight types: sports, culture, music, creative activities, gardening, radio and TV, sightseeing, and investment/gambling. The Cox proportional-hazards regression model was used to determine an age-adjusted hazard ratio (HR) for each in both males and females. Subsequently, those factors with a significant HR were used as predictive variables in stepwise regression for further clarification. RESULTS: At the end of the 3-year study, the number of subjects who received Certification associated with dementia was 330 (139 males, 191 females); 9,390 were otherwise categorized. The percentage of Certified subjects was 1.13 per year. The following predictive factors showed significant HRs: in both the male and female groups, self-awareness of forgetfulness (male 1.69, female 2.59) and 4 points or less in instrumental independence scores (male 1.80, female 2.23); in the males, living alone (2.39), subjective poor health (2.04), no work (1.80) 3 points or less in intellectual activity score (2.13), and no gardening (1.99); and in the female group, no sports (1.92) CONCLUSION: The study found that the occurrence of Certification associated with dementia is less in those who are enjoying good psychosocial/daily life conditions, in males involved in gardening, and in females involved in sports. Thus the study suggests the importance of focusing on these factors, more so than health behavior, in terms of progressive dementia prevention.