The Impact of Generativity on Maintaining Higher-Level Functional Capacity of Older Adults: A Longitudinal Study in Japan.

Generativity is defined as an individual's concern for and actions dedicated toward the well-being of others, especially youth and subsequent generations. It is a key stage of psychological development from midlife to older age and can be a guiding concept for promoting engagement of older adults in productive and contributive activities, which benefit their well-being. This study examined the longitudinal association between generativity and higher-level functional capacity (HLFC) decline in older Japanese adults. The two-year longitudinal data of 879 older adults aged 65-84 years were analyzed. Participants' HLFC and generativity were assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence and the Revised Japanese version of the Generativity Scale, respectively. The binary logistic regression analysis results showed that a higher generativity score was negatively associated with HLFC decline, indicating that generativity effectively prevents HLFC decline over 2 years. On adding the interaction term between generativity and sex to examine whether the protective effect of generativity differed by sex, we found that generativity was especially effective in protecting the HLFC decline in men with higher generativity. The study results highlight the importance of promoting engagement of older adults in generative activities to maintain their HLFC.

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).

Digitally Inclusive, Healthy Aging Communities (DIHAC): A Cross-Cultural Study in Japan, Republic of Korea, Singapore, and Thailand.

One out of three people in Japan will be an older person before 2040. Half of those currently do not utilize the internet, smartphone apps, or digital technology. On the other hand, more than 70% of seniors in Republic of Korea use the internet, and 55% in Singapore had access to it in 2019. The use of digital technology for health promotion has the potential to promote individual and community empowerment, advocating for healthy, active aging. Maintaining equity in health promotion practice requires the digital inclusion of every senior. Therefore, we propose a cross-cultural study to explain the contextual influences of digital inclusion and its consequences on healthy aging in Japan, Korea, Singapore, and Thailand. Quantitatively: digital skills, e-health literacy, participation in health promotion, and quality of life will be analyzed in structural equation models. Qualitatively: thematic analysis will be developed to identify cultural patterns and contextual factors, making sense of what older persons in different countries materialize, say, do, think, and feel to reveal deeper beliefs and core values about digital inclusion and healthy aging. Logics and methods from this protocol would be useful to replicate the study in many countries globally. Evidence from this study is expected to pave the way to digitally inclusive, healthy aging communities (DIHAC) across Japan and Asia.

[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.

Influence of "Face-to-Face Contact" and "Non-Face-to-Face Contact" on the Subsequent Decline in Self-Rated Health and Mental Health Status of Young, Middle-Aged, and Older Japanese Adults: A Two-Year Prospective Study.

This study aims to identify the independent influence of face-to-face contact (FFC) and non-face-to-face contact (NFFC) on the subsequent decline in self-rated health and mental health status by age. A total of 12,000 participants were randomly selected among residents in the study area, and 1751 of them responded to both the 2016 and 2018 mail surveys. The participants were subsequently classified into three age groups (25-49: Young adults; 50-64: Mid-aged adults; and 65-84: Older adults). Social contact was assessed by computing the frequencies of FFC and NFFC. Multiple logistic regression analysis showed the risk of social contact on the decline in self-rated health and World Health Organization-Five Well-Being Index. Both FFC and NFFC were significantly associated with maintaining mental health; however, the impacts of FFC on mental health were more significant than that of NFFC among older adults and young adults. Compared with the no contact group, FFC was significantly associated with maintaining self-rated health in mid-aged adults. The influence of FFC and NFFC on health differed by age group.

[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.

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan.

OBJECTIVE: To examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults. METHODS: Postal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model). RESULTS: Almost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303-0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338-3.470). DISCUSSION: Older adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.

Workplace and community social capital and burnout among professionals of health and welfare services for the seniors: A multilevel analysis in Japan.

OBJECTIVE: Despite the potential of the social capital approach in preventing burnout, there is sparse evidence of its contextual effect. This study aimed to reveal the contextual association of workplace and community social capital on burnout among professionals of health and welfare services for seniors in Japan. METHODS: We collected data from a cross-sectional questionnaire survey for all health and welfare professionals working in Community Comprehensive Support Centers (CCSCs) in the central Tokyo area in 2015. We assessed burnout using the Japanese version of the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalization, and reduced personal accomplishment. We prepared social capital items regarding workplace (the CCSC the participants belonged to) and community (the current catchment area of the CCSC). We aggregated individual responses of workplace and community social capital within each CCSC to create group-level workplace and community social capital indicators. RESULTS: Among the 1771 questionnaires distributed, we analyzed 1110 from 211 CCSCs. Multilevel analysis showed that higher group-level workplace social capital was significantly associated with lower scores of all three subscales after adjusting for covariates. Moreover, we found a significant association between greater group-level community social capital and lower scores of depersonalization and reduced personal accomplishment. CONCLUSION: Working in workplaces and communities with higher social capital is related to lower burnout. The findings suggest that strategies to enhance the social capital of their workplace and community would be beneficial in the prevention of burnout among professionals in the field of health and social welfare.

[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.

Working for only financial reasons attenuates the health effects of working beyond retirement age: A 2-year longitudinal study.

AIM: The health benefits of paid employment in late life are understood, but they might vary according to work motives. We examined the health effects of employment among older adults, focusing on motivation. METHODS: We carried out a 2-year longitudinal survey from 2013 (baseline) to 2015 (follow up). Among 7608 older adults, the analysis included 1069 who completed both surveys and were employed at baseline. Work motives were assessed using a questionnaire. Participants were assigned to groups based on their responses: (i) financial reasons; (ii) motivation other than financial reasons; and (iii) both financial and non-financial reasons. Self-rated health, mental health and higher-level functional capacity were evaluated as health outcomes. RESULTS: There were group differences in baseline demographic variables and health status; those with financial reasons had lower socioeconomic status and worse mental health. Multivariable logistic regression analysis showed that compared with older workers with non-financial reasons, those with financial reasons were more likely to decline in self-rated health (OR 1.42; 95% CI 1.00-2.03) and higher-level functional capacity (OR 1.55; 95% CI 1.16-2.07), which was independent of potential covariates, including socioeconomic status. However, no differences were evident between those with only non-financial reasons and those having both financial and non-financial reasons. CONCLUSIONS: We found that the participants who worked only for financial rewards had reduced health benefits through working in old age. A prolonged working life among older workers can contribute to maintaining health and can be enhanced by non-financial reasons, such as finding meaning in life and social contact. Geriatr Gerontol Int 2020; 20: 745-751.

Factors relating to social isolation in urban Japanese older people: A 2-year prospective cohort study.

PURPOSE: We analyzed the data from a 2-year prospective-cohort survey to identify factors relating to new incidences of social isolation and recovery from social isolation in community-dwelling older people. MATERIALS AND METHODS: We conducted a longitudinal study (2013-2015) involving 2657 older residents of Iriarai, Japan. A chi-square test, an independent t-test, and logistic regression analysis with imputed data were conducted to examine categorical data, continuous variables, and factors relating to social isolation, respectively. PRINCIPAL RESULTS: The results suggested that the factors that predicted future social isolation included being a man, being older, living with others, having a decline in mental health, having a lower frequency of going out, and not participating in community groups. On the other hand, being younger, having a higher level of mental health, having a higher frequency of going out, and participating in community groups were identified as factors that predicted participants' recovery from social isolation. MAJOR CONCLUSIONS: Some demographic, mental, and social factors could relate to new incidences of social isolation and recovery from social isolation in community-dwelling older people. As aging is an irreversible phenomenon, and there is a limit to preventing all disorders, either building a safety net or introducing exchange programs to prevent social isolation are important interventions for older people.

[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.

Is unwilling volunteering protective for functional decline? The interactive effects of volunteer willingness and engagement on health in a 3-year longitudinal study of Japanese older adults.

AIM: The present study explored the interactive effects of willingness to volunteer and actual volunteer engagement on the maintenance of functional health among older Japanese adults, using data from a 3-year longitudinal study. METHODS: We used data from the 3-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (1997). We examined 676 older adults aged >65 years from the rural Nangai District who were independent in their basic activities of daily living (BADL). A follow-up study was carried out in 2000. We categorized participants into four groups: "willing volunteers," "unwilling volunteers," "willing non-volunteers" and "unwilling non-volunteers." Logistic regression analyses were carried out to evaluate the interactive effects of willingness to volunteer and actual engagement in volunteering at baseline on BADL decline over a 3-year period. RESULTS: During the follow-up period, 6.6% of willing volunteers, 17.4% of unwilling volunteers, 16.3% of willing non-volunteers and 21.0% of unwilling non-volunteers experienced a decline in BADL. Unwilling volunteers (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.29-6.43) and both non-volunteer groups (willing: OR 2.70, 95% CI 1.28-5.72; unwilling: OR 2.48, 95% CI 1.32-4.64) had significantly higher odds of BADL decline than did willing volunteers. When unwilling non-volunteer was set as the reference, the OR of unwilling volunteers became 1.16 (95% CI 0.55-2.49), suggesting that unwilling volunteers had a similar odds of BADL decline as non-volunteers. CONCLUSION: Volunteer activity is effective for preventing BADL decline only for those who willingly engage. Geriatr Gerontol Int 2019; 19: 673-678.

[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.

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.