Spatial and temporal indoor temperature differences at home and perceived coldness in winter: A cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan.

Residents themselves are responsible for controlling their living environment, and their perception of coldness is important to protect their health. Although previous studies examined the association between perceived coldness and indoor temperature, they did not consider the spatial-temporal differences in indoor temperatures. This study, conducted in Japan, measured indoor temperatures in 1,553 houses across several rooms (living room, changing room, and bedroom) and heights (at 1 m above the floor and near the floor) over two weeks and obtained the perceived coldness from 2,793 participants during winter. Results showed substantial temperature differences between rooms (horizontal differences): 3.8 °C between living and changing rooms, and 4.1 °C between living rooms and bedrooms. The average vertical and diel (evening-morning) temperature differences in the living room were 3.1 °C and 3.0 °C, respectively. Regional analysis revealed that the Tohoku region experienced larger horizontal and diel indoor temperature differences, primarily due to its practice of intermittent and partial heating in living rooms only, in contrast to Hokkaido's approach of heating the entire house continuously. Despite Hokkaido's comprehensive heating system, it exhibited the largest vertical temperature difference of 5.1 °C in living rooms, highlighting the insufficiency of heating alone and the necessity for enhanced thermal insulation. The multivariate logistic regression analyses showed that average temperatures and vertical temperature differences were associated with perceived coldness, while horizontal and diel differences did not show a significant association, further emphasizing the importance of improved thermal insulation. Moreover, factors like individual attributes (age and gender), and lifestyle choices (meal quantity, exercise habits, alcohol consumption, and clothing amount) were significantly associated with coldness perception. Notably, older adults were less likely to perceive coldness but more vulnerable to the health impacts of low temperatures, underscoring the necessity of not solely relying on human perception for indoor temperature management to protect cold-related health problems.

Role of housing in blood pressure control: a review of evidence from the Smart Wellness Housing survey in Japan.

Current countermeasures for preventing hypertension emphasize only improvements to lifestyle. Recently, improving life environment has attracted attention, in parallel with publication of the WHO Housing and health guidelines. We quantitatively evaluated the relationship between housing thermal environment and blood pressure (BP) in a real-world setting. We conducted a nationwide, prospective intervention study-the Smart Wellness Housing survey-in Japan, as a non-randomized controlled trial. The intervention was the retrofitting of thermal insulation in houses. Participant recruitment was done by construction companies in all 47 prefectures of Japan. Measurements of home BP and indoor temperature at 1.0 m above the floor in the living room, changing room, and bedroom were taken for 2 weeks before and after the intervention each winter (November-March) of FY 2014-2019. As of July 2022, over 2500 households and 5000 participants were registered in the database. We found that (1) about 90% of Japanese lived in cold homes (minimum indoor temperature <18 °C), (2) indoor temperature was non-linearly associated with home BP, (3) morning systolic BP (SBP) was more sensitive than evening SBP to changes in indoor temperature, (4) SBP was influenced by indoor temperature change particularly in older participants and women, (5) unstable indoor temperature was associated with large BP variability, and (6) insulation retrofitting intervention significantly reduced home BP, especially in hypertensive patients. We proposed that the BP reduction effect of the life-environment is comparable to that achievable by lifestyle.

Association between Indoor Temperature in Winter and Serum Cholesterol: A Cross-Sectional Analysis of the Smart Wellness Housing Survey in Japan.

AIM: Issuance of the WHO Housing and health guidelines has paralleled growing interest in the housing environment. Despite accumulating evidence of an association between outdoor temperature and serum cholesterol, indoor temperature has not been well investigated. This study examined the association between indoor temperature and serum cholesterol. METHODS: We collected valid health checkup data of 2004 participants (1333 households), measured the indoor temperature for 2 weeks in winter, and divided participants according to whether they lived in a warm (average bedroom temperature ≥ 18℃), slightly cold (12-18℃) or cold house (＜12˚C). The relationship between bedroom temperature and serum cholesterol was analyzed using multivariate logistic regression models, adjusting for demographics, lifestyle habits and the season in which the health checkup was conducted, with a random effect of climate areas in Japan. RESULTS: The sample sizes for warm, slightly cold, and cold houses were 206, 940, and 858, respectively. Compared to those in warm houses, the odds ratio of total cholesterol exceeding 220 mg/dL was 1.83 (95%CI: 1.23-2.71, p=0.003) for participants in slightly cold houses and 1.87 (95%CI: 1.25-2.80, p=0.002) in cold houses. Similarly, the odds ratio of LDL/non-HDL cholesterol exceeding the standard range was 1.49 (p=0.056)/1.67 (p=0.035) for those in slightly cold houses and 1.64 (p=0.020)/1.77 (p=0.021) in cold houses. HDL cholesterol and triglycerides were not significantly associated with bedroom temperature. CONCLUSION: Besides lifestyle modification, improving indoor thermal environment through strategies such as installing high thermal insulation and appropriate use of heating devices may contribute to better serum cholesterol condition.

[Descriptive epidemiology of winter indoor and outdoor temperatures and their relationships based on SWH survey].

Objectives　The purpose of this study was to make clear the descriptive epidemiology and the relationship between the room temperature of living room, bedroom, dressing room, and outdoor during winter, based on the climate areas in Japan.Methods　This study targeted 3,781 people, survey for 5 years from 2014, based on the Smart Wellness Housing (SWH) project, which was carried out nationwide with the support of the Ministry of Land, Infrastructure, Transport and Tourism. During winter, we recorded the outdoor temperature and living room, bedroom, and dressing room temperatures at 1 m above the floor and near the floor for two weeks. Covariance structure analyses were used to clarify the relationship between room temperature and outdoor temperature based on six climate areas in Japan. The analyses were performed using SPSS22.0 and AMOS22.0 for Windows.Results　The temperature near the floor inside the house was lower than the room temperature at 1 m above the floor, and both the room and near the floor temperature in the morning tended to be the lowest. The temperature disparity between the dressing room and living room was the largest. Based on climate areas, the room temperature in the Area 2 was the highest, while the room temperature in the Area 4 was the lowest. The outdoor temperature was more closely associated with the room temperature near the floor than the room temperature at 1 m above the floor, especially in the southern Areas, except Area 7.Conclusion　The temperature near the floor inside the house was lower than room temperature at 1 m above the floor. The temperature disparity between dressing room and living room was the largest. The room temperature and near the floor temperature were lowest in the energy-saving Area 4. The outdoor temperature was more closely associated with the room temperature near the floor than the room temperature at 1 m above the floor, especially in the southern Areas, except Area 7.

Electrocardiogram abnormalities in residents in cold homes: a cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan.

BACKGROUND: Excess winter mortality caused by cardiovascular disease is particularly profound in cold houses. Consistent with this, accumulating evidence indicates that low indoor temperatures at home increase blood pressure. However, it remains unclear whether low indoor temperatures affect other cardiovascular biomarkers. In its latest list of priority medical devices for management of cardiovascular diseases, the World Health Organization (WHO) included electrocardiography systems as capital medical devices. We therefore examined the association between indoor temperature and electrocardiogram findings. METHODS: We collected electrocardiogram data from 1480 participants during health checkups. We also measured the indoor temperature in the living room and bedroom for 2 weeks in winter, and divided participants into those living in warm houses (average exposure temperature ≥ 18 °C), slightly cold houses (12-18 °C), and cold houses (< 12 °C) in accordance with guidelines issued by the WHO and United Kingdom. The association between indoor temperature (warm vs. slightly cold vs. cold houses) and electrocardiogram findings was analyzed using multivariate logistic regression models, with adjustment for confounders such as demographics (e.g., age, sex, body mass index, household income), lifestyle (e.g., eating habit, exercise, smoking, alcohol drinking), and region. RESULTS: The average temperature at home was 14.7 °C, and 238, 924, and 318 participants lived in warm, slightly cold, and cold houses, respectively. Electrocardiogram abnormalities were observed in 17.6%, 25.4%, and 30.2% of participants living in warm, slightly cold, and cold houses, respectively (p = 0.003, chi-squared test). Compared to participants living in warm houses, the odds ratio of having electrocardiogram abnormalities was 1.79 (95% confidence interval: 1.14-2.81, p = 0.011) for those living in slightly cold houses and 2.18 (95% confidence interval: 1.27-3.75, p = 0.005) for those living in cold houses. CONCLUSIONS: In addition to blood pressure, living in cold houses may have adverse effects on electrocardiogram. Conversely, keeping the indoor thermal environment within an appropriate range through a combination of living in highly thermal insulated houses and appropriate use of heating devices may contribute to good cardiovascular health. TRIAL REGISTRATION: The trial was retrospectively registered on 27 Dec 2017 to the University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, https://www.umin.ac.jp/ctr/ , registration identifier number UMIN000030601 ).

Impact of indoor temperature instability on diurnal and day-by-day variability of home blood pressure in winter: a nationwide Smart Wellness Housing survey in Japan.

Home blood pressure (HBP) variability is an important factor for cardiovascular events. While several studies have examined the effects of individual attributes and lifestyle factors on reducing HBP variability, the effects of living environment remain unknown. We hypothesized that a stable home thermal environment contributes to reducing HBP variability. We conducted an epidemiological survey on HBP and indoor temperature in 3785 participants (2162 households) planning to have their houses retrofitted with insulation. HBP was measured twice in the morning and evening for 2 weeks in winter. Indoor temperature was recorded with each HBP observation. We calculated the morning-evening (ME) difference as an index of diurnal variability and the standard deviation (SD), coefficient of variation (CV), average real variability (ARV) and variability independent of the mean (VIM) as indices of day-by-day variability. The association between BP variability and temperature instability was analyzed using multiple linear regression models. The mean ME difference in indoor/outdoor temperature (a decrease in temperature overnight) was 3.2/1.5 °C, and the mean SD of indoor/outdoor temperature was 1.6/2.5 °C. Linear regression analyses showed that the ME difference in indoor temperature was closely correlated with the ME difference in systolic BP (0.85 mmHg/°C, p < 0.001). The SD of indoor temperature was also associated with the SD of systolic BP (0.61 mmHg/°C, p < 0.001). The CV, ARV, and VIM showed similar trends as the SD of BP. In contrast, outdoor temperature instability was not associated with either diurnal or day-by-day HBP variability. Therefore, residents should keep the indoor temperature stable to reduce BP variability.

Decline in independence after three years and its association with dietary patterns and IADL-related factors in community-dwelling older people: an analysis by age stage and sex.

BACKGROUND: Few studies have shown age stage and sex differences in the association among dietary patterns and various health factors related to disability in older people. This study aimed to reveal the differences of characteristics, including several dietary patterns, associated with a decline in independence over 3 years in community-dwelling independent older people. Specifically, we examined data by age stage, for people between 65 and 75 years (earlier-stage) and people aged 75 years or above (later-stage), and sex. METHODS: We conducted a nationwide longitudinal study of 25 Japanese prefectures from 2013 to 2016; 2250 participants' complete data (1294 men and 956 women) were analyzed. Independence was evaluated based on instrumental activities of daily living (IADL) scores (maximum = 12). Dietary patterns were derived from a principal component analysis of the seven food groups. Baseline IADL-related factors linked to independence 3 years later were selected. Multiple logistic regression analysis for having low independence-without a full score of IADL 3 years after baseline-was conducted, adjusted for baseline IADL scores. Finally, to compare differences among age stage and sex groups, we used Multiple-Group Path Analysis. RESULTS: Participants with a full IADL score 3 years later were classified as high independence (69.6%), and those without the full score were classified as low independence (30.4%). Only the later-stage older peoples' proportion of low independence 3 years later was significantly higher than those at baseline. A high meat frequency pattern was associated with a significantly higher risk of decline in independence 3 years later in later-stage older women. The earlier-stage older people showed that 18.5 ≤ BMI < 25 was associated with a lower risk, referring to BMI < 18.5. In the later-stage, exercising three or more times a week with enjoyment and fulfillment was associated with a significantly lower risk. CONCLUSIONS: The IADL disability in older people aged 75 and over showed a rapid change. The different characteristics associated with the risk of decline in independence among age stage and sex were revealed. Targeting age stage and sex separately for community-based comprehensive supportive strategies would be necessary for a long life globally.

Disparities of indoor temperature in winter: A cross-sectional analysis of the Nationwide Smart Wellness Housing Survey in Japan.

The WHO Housing and health guidelines recommend a minimum indoor temperature of 18°C to prevent cold-related diseases. In Japan, indoor temperatures appear lower than in Euro-American countries because of low insulation standards and use of partial intermittent heating. This study investigated the actual status of indoor temperatures in Japan and the common characteristics of residents who live in cold homes. We conducted a nationwide real-world survey on indoor temperature for 2 weeks in winter. Cross-sectional analyses involving 2190 houses showed that average living room, changing room, and bedroom temperatures were 16.8°C, 13.0°C, and 12.8°C, respectively. Comparison of average living room temperature between prefectures revealed a maximum difference of 6.7°C (Hokkaido: 19.8°C, Kagawa: 13.1°C). Compared to the high-income group, the odds ratio for living room temperature falling below 18°C was 1.38 (95% CI: 1.04-1.84) and 2.07 (95% CI: 1.28-3.33) for the middle- and low-income groups. The odds ratio was 1.96 (95% CI: 1.19-3.22) for single-person households, compared to households living with housemates. Furthermore, lower room temperature was correlated with local heating device use and a larger amount of clothes. These results will be useful in the development of prevention strategies for residents who live in cold homes.

Intervention study of the effect of insulation retrofitting on home blood pressure in winter: a nationwide Smart Wellness Housing survey.

OBJECTIVE: The WHO's Housing and health guidelines (2018) listed 'low indoor temperatures and insulation' as one of five priority areas, and indicated insulation retrofitting to help mitigate the effect of low indoor temperatures on health. However, there is still not enough evidence for the effect of insulation retrofitting based on an objective index. METHODS: We conducted a nonrandomized controlled trial comparing home blood pressure (HBP) between insulation retrofitting (942 households and 1578 participants) and noninsulation retrofitting groups (67 households and 107 participants). HBP and indoor temperature were measured for 2 weeks before and after the intervention in winter. To examine the influence of insulation retrofitting on HBP, we used multiple linear regression analysis. RESULTS: The analyses showed that indoor temperature in the morning rose by 1.4°C after insulation retrofitting, despite a slight decrease in outdoor temperature by 0.2°C. Insulation retrofitting significantly reduced morning home SBP (HSBP) by 3.1 mmHg [95% confidence interval (95% CI): 1.5-4.6], morning home DBP (HDBP) by 2.1 mmHg (95% CI: 1.1-3.2), evening HSBP by 1.8 mmHg (95% CI: 0.2-3.4) and evening HDBP by 1.5 mmHg (95% CI: 0.4-2.6). In addition, there was a dose-response relationship between indoor temperature and HBP, indicating the effectiveness of a significant improvement in the indoor thermal environment. Furthermore, there was heterogeneity in the effect of insulation retrofitting on morning HSBP in hypertensive patients compared with normotensive occupants (-7.7 versus -2.2 mmHg, P for interaction = 0.043). CONCLUSION: Insulation retrofitting significantly reduced HBP and was more beneficial for reducing the morning HSBP of hypertensive patients.

Cross-Sectional Analysis of the Relationship Between Home Blood Pressure and Indoor Temperature in Winter: A Nationwide Smart Wellness Housing Survey in Japan.

Mortality due to cardiovascular disease rises sharply in winter. Known as excess winter mortality, this phenomenon is partially explained by cold exposure-induced high blood pressure. Home blood pressure, especially in the morning, is closely associated with cardiovascular disease risk. We conducted the first large nationwide survey on home blood pressure and indoor temperature in 3775 participants (2095 households) who intended to conduct insulation retrofitting and were recruited by construction companies. Home blood pressure was measured twice in the morning and evening for 2 weeks. The relationship between home blood pressure and indoor temperature in winter was analyzed using a multilevel model with 3 levels: repeatedly measured day-level variables (eg, indoor ambient temperature and quality of sleep), nested within individual-level (eg, age and sex), and nested within household level. Cross-sectional analyses involving about 2900 participants (1840 households) showed that systolic blood pressure in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mm Hg increase/10°C decrease) than that in the evening (6.5 mm Hg increase/10°C decrease) in participants aged 57 years (mean age in this survey). We also found a nonlinear relationship between morning systolic blood pressure and indoor temperature, suggesting that the effect of indoor temperature on blood pressure varied depending on room temperature range. Interaction terms between age/women and indoor temperature were significant, indicating that systolic blood pressure in older residents and women was vulnerable to indoor temperature change. We expect that these results will be useful in determining optimum home temperature recommendations for men and women of each age group. Clinical Trial Registration- URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000030601.

[Association between feelings of happiness among community-dwelling, independent, elderly individuals in an Okinawan farm village and survival three years later].

Objectives　As an indicator of subjective wellbeing, feelings of happiness assessed based on simple items have not been fully elucidated in terms of its relation to survival during old age. The purpose of this study was to examine whether the predictive validity of feelings of happiness assessed using a 4-item measure is high as an indicator of assessing survival three years later, using a variety of factors as adjustment variables among independent, elderly individuals living in a farm village in Okinawa, wherein a spirit of mutual help is prevalent among the residents.Methods　From a longitudinal study conducted in 2012, a total of 1,471 respondents (638 men, 833 women), excluding participants who needed long-term care and non-respondents of their feelings of happiness, completed a detailed questionnaire. A 4-item measure of feelings of happiness and other indicators of subjective wellbeing, including a 5-item measure of cooked food consumption, were considered as ordinal scales. From the results of the principal component (PC) analysis, we named the first PC "diet variety," of which cooked food was less consumed. The Cox proportional hazard model was used for 734 subjects' data, excluding missing values, to examine comprehensive associations among feelings of happiness, survival times, and health indicators in a multivariate model that adjusted for age, sex, and body mass index, among others. A correlation analysis between survival after three years was performed to select indicators used simultaneously in the analysis. Kaplan-Meier analysis was also conducted to examine the cumulative survival rate over three years.Results　A total of 1,387 participants (94.3%) survived during the three-year follow-up. The survival rate was significantly higher in those who indicated "very happy" items (95.9%) than in those who indicated "unhappy" items (86.4%). Meanwhile, the mortality rate was significantly higher in those who indicated "unhappy" items (13.6%) than in those who indicated "very happy" items (4.1%). Within the multivariate model, the hazard ratio (HR) for mortality three years later was significantly reduced in those with feelings of happiness (HR=0.56, 95% confidence interval [CI]: 0.32-0.99), in those who did not experiences falls and fractures (HR=0.26, 95% CI:0.11-0.62), and in those who were non-smokers (HR=0.44, 95% CI:0.25-0.77). The cumulative survival rate in those who experienced good feelings of happiness was significantly higher than in the others.Conclusion　The predictive validity of feelings of happiness assessed by a 4-item measure might be high as an indicator to assess survival three years later among independent, elderly individuals living in a farm village in Okinawa.

Lower Physical Performance in Colder Seasons and Colder Houses: Evidence from a Field Study on Older People Living in the Community.

The aim of this paper was to explore the effect of seasonal temperature differences and cold indoor environment in winter on the physical performance of older people living in the community based on a field study. We recruited 162 home-dwelling older people from a rehabilitation facility in the Osaka prefecture, Japan; physical performance data were available from 98/162 (60.5%). At the same time, for some participants, a questionnaire survey and a measurement of the indoor temperature of individual houses were conducted. The analysis showed that there were seasonal trends in the physical performance of older people and that physical performance was worse in the winter compared with the autumn. Furthermore, people living in colder houses had worse physical performance. The findings indicate that keeping the house warm in the winter can help to maintain physical performance.

Dietary quality and its structural relationships among equivalent income, emotional well-being, and a five-year subjective health in Japanese middle-aged urban dwellers.

BACKGROUND: Although dietary quality in middle-age and the prime age of a person's work career might be determined by positive emotional well-being based on socioeconomic status (SES), causation among determinants of dietary quality still remains unclear. Our purpose was to elucidate the structural relationships among five-year prior dietary quality, equivalent income, emotional well-being, and a five-year subjective health by sex and age group separately. METHODS: In 2003, 10,000 middle-aged urban dwellers aged 40-64 years, who lived in ward A in the Tokyo metropolitan area, were randomly selected and a questionnaire survey was conducted by mail. In 2008, we made a follow-up survey for dwellers, and were able to gather their survival status. A total of 2507, middle-aged men (n = 1112) and women (n = 1395), were examined at baseline. We created three latent variables for a structural equation modeling (SEM), five-year subjective health reported in 2003 and in 2008, dietary quality of principle food groups diversity and eating behavior in 2003, and emotional well-being constructed by enjoyment & ikigai (meaning of life) and by close people in 2003. Equivalent income in 2003 was calculated as SES indicator. RESULTS: In the SEM analysis of both men and women, there was an indirect effect of the equivalent income on dietary quality and on five-year subjective health, via emotional well-being explained by ikigai and having comforting people close to the individuals, significantly. There tended to be a larger direct effect of emotional well-being on the dietary quality in men than in women, and also a larger effect accompanying with aging. In women, there was a large direct effect of equivalent income on dietary quality than in men. When examined comprehensively, there appeared to be a larger effect of five-year prior equivalent income on subjective health during five-year in men than in women. CONCLUSION: This study suggests that it is necessary to support the improvement of dietary quality in middle age by considering the characteristics of sex and age group and also by providing supportive environment to enhance emotional well-being based on equivalent income, cooperating different field professionals to provide such as employment or community support program.

Association between socioeconomic status (SES), mental health and need for long-term care (NLTC)-A Longitudinal Study among the Japanese Elderly.

This study was carried out to explore the relationship between the SES, mental health and the NLTC of the Japanese elderly, with the aim of providing useful information to lower the NLTC. A longitudinal survey was carried out in Tama City, Tokyo in 2001 and 2004. Data were collected from the urban-dwelling older adults, aged 65 years old and above, through self-reported questionnaires, which was participated by 7905 respondents (47.6% male and 52.4% female). Chi-square test, Kendall tau-b correlation analysis and structural equation modeling (SEM) were used to identify the association between SES, mental health and NLTC. The results of the SEM analysis indicated that mental health would exert a negative effect on NLTC for both the elderly men and the elderly women, while the effect was stronger for the elderly women; SES was significantly and negatively associated to NLTC, both for the elderly men and elderly women; a significant and positive relationship was observed between SES and mental health for both genders, but slightly stronger for the elderly men. These findings have implications for targeting the interventions that are aimed to delaying the NLTC and the financing of LTC system.

Socioeconomic status, comorbidity, activity limitation, and healthy life expectancy in older men and women: a 6-year follow-up study in Japan.

This study aimed to explore the structural contributions of socioeconomic status (SES), comorbidity, and activity limitation to the healthy life expectancy (HALE) of Japanese suburban elderly. A questionnaire survey was distributed to all residents aged 65 years and older in Tama City, Tokyo, in 2001; a follow-up study was conducted in 2004; and individual vital status data from the municipal residents' registry were tracked until 2007. In all, 7,905 respondents were included for analysis. Data analysis was performed by structural equation modeling (SEM). The data were well fit by the models, and HALE was found to be well explained by SES, comorbidity, and activity limitation (R (2) = .59 for men and R (2) = .71 for women). In conclusion, elderly people with higher SES were more likely to live longer with good self-rated health, via living with less chronic diseases and better performance in daily living activities, especially for elderly women.

The effects of socio-economic status and physical health on the long-term care needs of Japanese urban elderly: a chronological study.

OBJECTIVES: The aim of this chronological study was to elucidate the effects of socio-economic status (SES) and physical health on the long-term care (LTC) needs of a Japanese elderly population and to explore their causal relationships. METHODS: A self-administered questionnaire was distributed to all residents aged 65 years and older of Tama City, Tokyo, in September 2001. A total of 13,195 completed questionnaires were returned, giving a response rate of 80.2 %. A follow-up study was done using the same questionnaire in 2004. Ultimately, 7,905 respondents were included in our analysis. Data analysis was performed using correlation analysis and structural equation modeling (SEM). For SEM, we used one observed variable (LTC needs in 2004) and three latent variables (SES in 2001 and physical health in both 2001 and 2004). RESULTS: The data were well fit by the models, with a NFI of 0.980, CFI of 0.982, and RMSEA of 0.032. LTC needs were well explained by the three latent variables (R (2) = 0.70 and 0.66 for elderly men and women, respectively). Among all variables, physical health in 2004 was the strongest determinant of LTC needs, followed by physical health in 2001, and SES in 2001. Gender differences in the structural relationships were minor. CONCLUSIONS: Our results indicate that good physical health directly contributes to reducing LTC needs among Japanese elderly. In addition, efforts to increase income and educational levels may help to decrease LTC needs by indirectly improving physical health.

[Risk factors for falls and survival after falling in elderly people in a community].

OBJECTIVES: The purpose of this study was to assess the risk factors associated with falls and to examine the effects of falls on survival of elderly people in a community. METHODS: A questionnaire survey was conducted in 16,462 urban elderly dwellers aged 65 years or more in City A in September 2001. A follow-up survey was carried out in September 2004. We analyzed the data of 8,285 subjects who answered both questionnaires and had not relocated by August 2007. Baseline assessments of health and functioning were carried out in 2001. Falls experienced during the 1-year period before September 2004 were recorded, and the deaths were recorded until August 2007. Statistical analysis was performed using a logistic regression model and Cox's proportional hazards analysis. RESULTS: A total of 6,420 subjects (3,127 men and 3,293 women) who had provided complete answers about their falls were included in the analyses. Of these, 27.8% of women and 16.4% of men had experienced falls, while 6.2% of women and 2.1% of men had experienced falls that caused fractures. We found that the likelihood of fall, with or without fracture development, was greater in women than in men (P < 0.001). The rate of falls tended to increase with age in both women and men. Risk factors associated with falls, in addition to age and gender, were pain (odds ratio [OR], 1.75), lack of instrumental activities of daily living (IADL; OR, 1.45), poor self-rated health status (OR, 1.42), and presence of disease (OR, 1.35). Risk factors associated with falls that caused fracture were pain (OR, 1.85) and lack of IADL (OR, 1.61). Cox's proportional hazards analysis showed a significant increase in mortality in both men and women who had experienced falls than in those who had not (hazard ratio [HR], 1.94, 1.43). CONCLUSION: Aging, pain and disease, lack of IADL, and poor self-rated health status were all significant risk factors for falls in elderly people, and a fall was related to subsequent mortality.

[Chronological evaluation of physical, psychological and social health of urban elderly dwellers over 6 years and assessment of causal inter-relationships].

OBJECTIVES: The purpose of this study is to make a chronological evaluation over 6 years of physical, psychological and social health of urban elderly dwellers. METHODS: A questionnaire survey was conducted with all urban elderly dwellers of 65 years old or more in A City in September, 2001. Answers were obtained from 13,195 people (response rate of 80.2%) in the first survey. Then 3 year and 6 year follow-up surveys of 2,375 members were performed in September 2004 and 2007. Causal relationships were analyzed using a Structural Equation Model based on the Cross-Lagged Effects Variation Model. RESULTS: According to this research, a chronological six year trend in ADL (Activities of Daily Living) was found for "physical factor" (" " means latent variable) as an observed variable, with a shifted from 91.0% to 82.9%. A trend for self-rated health with healthy as an observed variable of "psychological factor" was similarly apparent, shifting from 85.4% to 77.0%. "Social factor" conducted on the follow-up survey in 2007 was significantly affected by the "psychological factor" investigated in 2001 and "physical factor" in the follow-up survey in 2004, indirectly based on the Cross-Lagged Effects Variation Model. "Social factor" totals of 25% for men and 19% for women were explained by this model with high validity levels (NFI = 0.935, IFI = 0.950, RMSEA = 0.036). CONCLUSION: It was suggested that social health was affected by psychological health directly and physical health indirectly during six years follow-up of urban elderly dwellers. Future research is needed to encompass other generations and also to improve the external validity of the results.

[The relationship between students' well-being and their parents' knowledge and support in a metropolitan area].

OBJECTIVES: The purpose of this study was to clarify the causal relationship between students' well-being and their parents' knowledge and support in raising them in a prefecture by using covariance structural analysis. METHODS: In November 2007, a questionnaire survey was conducted with 11,363 elementary school students (4th grade),junior high school students (1st grade) and high school students (1st grade) as well as their parents. The total number of responses analyzed were 9,651 pairs of matched data for parents and their children. RESULTS: A concept model was proposed to use four latent variables determined by factor analysis. "Students' well-being" (" " means latent variable) classified as a latent variable, was not prescribed directly by "parents' knowledge and support", but rather developed indirectly through "physical activities" and "communication between the students and parents". The decision coefficients for the students' well-being determined with this model ranged from 27% to 40%. Depending on the participant's age and gender, they were divided into six groups. CONCLUSION: This study indicated that positive support for children's health and well-being by the parents was important for students to have a happy and healthy lifestyle. It became structurally clear that it was necessary for both students and their parents to engage in physical activities and have good communication with each other in order to stimulate and develop children's health practice and well-being.