Determinants of Self-Rated Health Disparities among Independent Community-Dwelling Older Adults: An Age-Stratified Analysis.

In response to the distinctive healthcare requirements of independent, healthy, community-dwelling older adults in Japan and other developed countries with aging populations, the current study examined the differences in factors associated with self-rated health (SRH) between the following two age groups: young-old (65-74) and old-old (75 and above). Age-stratified analysis was used to provide a comprehensive understanding of the unique health challenges faced by these demographic segments and to inform the development of targeted interventions and health policies to improve their well-being. The results of a cross-sectional study of 846 older adults in Yokohama, Japan, who completed self-administered questionnaires, revealed that high SRH was consistently linked with the low prevalence of concurrent medical issues in both age groups (<75 and ≥75) (ß: -0.323, p < 0.001 in the <75 group; ß: -0.232, p < 0.001 in the ≥75 group) and increased subjective well-being (ß: 0.357, p < 0.001 in the <75 group; ß: 0.244, p < 0.001 in the ≥75 group). Within the ≥75 age group, higher SRH was associated with more favorable economic status (ß: 0.164, p < 0.001) and increased engagement in social activities (ß: 0.117, p = 0.008), even after adjusting for age, sex, and economic status. These findings may inform the development of targeted interventions and policies to enhance the well-being of this growing population in Japan and other developed countries.

Development of the Self-efficacy for Social Participation scale (SOSA) for community-dwelling older adults.

BACKGROUND: Social participation is important for the health of older adults and super-aging societies. However, relatively few independent older adults in advanced countries actually participate in society, even though many of them have the capacity to do so. One possible reason for this could be a lack of self-efficacy for social participation. However, few scales have been developed to measure self-efficacy for social participation among community-dwelling independent older adults. Therefore, we developed the "Self-efficacy for Social Participation" scale (SOSA) to assess the self-efficacy of community-dwelling independent older adults, and examined the scale's reliability and validity. METHODS: We distributed a self-administered mail survey to approximately 5,000 randomly selected independent older adults throughout Japan. The construct validity of the SOSA was determined using exploratory and confirmatory factor analyses. Criterion-related validity was assessed using the General Self-Efficacy Scale (GSES) and according to subjective health status. RESULTS: In total, 1,336 older adults responded to the survey. Exploratory and confirmatory factor analyses identified 12 items distributed among four factors: instrumental self-efficacy, managerial self-efficacy, interpersonal self-efficacy and cultural self-efficacy. The final model had a Cronbach's alpha of 0.90, goodness-of-fit index of 0.948, adjusted goodness-of-fit index of 0.915, comparative fit index of 0.952, and root mean square error of approximation of 0.078. Significant correlations existed between the SOSA score and GSES (r = 0.550, p < 0.01) and subjective health status (r = 0.384, p < 0.01) scores. CONCLUSIONS: The SOSA showed sufficient reliability and validity to assess self-efficacy for social participation among older adults. This scale could aid efforts to improve the physical and mental health, and longevity, of older adults through increased behavioralizing social participation.

Factors related to subjective well-being among community-dwelling older adults living alone: A stratified analysis by sex and marital status from the JAGES.

BACKGROUND: Previous cross-sectional studies suggest that negative health outcomes such as mortality, social isolation, loneliness, and depression among older adults living alone vary by sex and marital status, with men often worse off than women and unmarried people worse off than married people. However, limited evidence exists from longitudinal studies regarding whether positive health outcomes such as subjective well-being (SWB) also vary by sex and marital status. The focus by sex and marital status on the positive health outcomes and diverse profiles of older adults living alone is important for public health in the near future. Therefore, the purpose of this study was to identify changes in SWB over time and its associated factors by sex and marital status among older adults living alone in the community using a longitudinal study in a representative population. METHODS: This was a longitudinal study using data from the Japan Gerontological Evaluation Study. This study is the first to reveal differences in SWB and related factors over 3 years among older adults living alone in the community (n = 8,579) who were stratified by sex and marital status (married men, non-married men, married women, and non-married women). RESULTS: Women moved to higher levels of SWB than did men, and married individuals moved to higher levels of SWB than did unmarried individuals. Independent functioning factors and interpersonal factors were significantly associated with SWB for married men and married women, but for unmarried women, the association by interpersonal factors was more pronounced, and for unmarried men, only limited emotional support and health promotion activities were significant among the interpersonal factors. CONCLUSIONS: This study revealed that among older adults living alone, changes in SWB over time and the independent functioning factors and interpersonal factors associated with this change varied by sex and marital status among older people living alone. These findings are useful for policy-making and guiding intervention activities to promote SWB in a society in which the environment for older adults living alone is changing dramatically.

Subjective Well-Being and Related Factors among Independent, Healthy, Community-Dwelling Older Adults in Japan.

(1) Background: Subjective well-being (SWB) is internationally recognized as an important health-related factor for most age groups and is particularly influential for life quality and expectancy in independent, healthy, community-dwelling older adults. However, the physical function and community participation correlates of SWB in independent living older adults in super-aging societies and other influencing factors remain underexplored. (2) Methods: A total of 926 independent, healthy, community-dwelling older adults aged 65 years and above registered in Yokohama, Japan, were included. Respondents' mean age was 78.1 years (standard deviation = 6.7), and 74.0% were women. The dependent variable was SWB. The independent variables were respondents' demographic characteristics, physical factors (visual, hearing, and cognitive functions, and mobility), and community and social factors (participation in community groups, social networks, and community commitment. (3) Results: The mean (standard deviation) WHO-5 score was 16.3 (5.1). Significant factors associated with WHO-5 score were visual function (odds ratio [OR]: 0.708; 95% confidence interval [CI]: 0.352-0.690), hearing function (OR: 0.615; CI: 0.431-0.878), community groups (OR: 1.310; CI: 1.003-1.059), community commitments (OR: 1.180; CI: 1.132-1.231), and social networks (OR: 1.525; CI: 1.142-2.037) adjusted for the effects of demographic factors. (4) Conclusions: These findings are important because factors associated with SWB are likely to contribute to individual well-being and longevity and to developing a healthy super-aged society.

Differences in Loneliness and Social Isolation among Community-Dwelling Older Adults by Household Type: A Nationwide Survey in Japan.

(1) Background: Social isolation and loneliness are determinants of healthy longevity. However, previous research has focused on either social isolation or loneliness and has not considered household types. This study sought to clarify loneliness and social isolation among older adults using single-person (ST) or multi-person (MT) household types. (2) Methods: We administered a national, anonymous, self-administered survey to 5351 Japanese older adults aged 65 years or older. The survey included subjects' demographic characteristics and scores for loneliness (University of California Los Angeles (UCLA) Loneliness Scale version 3 (Cronbach's α = 0.790)), social isolation (Lubben Social Network Scale (LSNS-6) (Cronbach's α = 0.82)), and self-efficacy (GSES). (3) Results: After adjusting for age and gender, ST individuals had significantly lower LSNS-6 and significantly higher UCLA scores than MT individuals (p < 0.001). Lower LSNS-6 and higher UCLA scores were significantly associated with lower GSES scores, and the effect of GSES was greater for ST than for MT (LSNS-6, ST (ß = 0.358, p < 0.001); MT (ß = 0.295, p < 0.001)) (UCLA, ST (ß = -0.476, p < 0.001); MT (ß = -0.381, p < 0.001)). (4) Conclusions: Specific healthcare systems and programs based on self-efficacy should be developed by household type to reduce both social isolation and loneliness.