Social participation and functional disability trajectories in the last three years of life: The Japan Gerontological Evaluation Study.

BACKGROUND: Functional disability has various patterns from onset until death. Although social participation is a known protective factor against functional disability among older individuals, it is unclear whether social participation is associated with the trajectory patterns of functional disability prior to death. This study assessed the association between social participation, specifically in horizontal and vertical groups, and the trajectories of functional disability prior to death. METHODS: We used survey data from the 2010 Japan Gerontological Evaluation Study for functionally independent older adults combined with public long-term care insurance system data from 2010 to 2016 (n = 4,502). The outcome variables included five previously identified trajectory patterns using group-based trajectory modeling. As the explanatory variable, we used three definitions of social participation: any group, horizontal group (e.g., sports, hobbies), or vertical group (e.g., political, religious), at least once a month. We used a multinomial logistic regression analysis to calculate odds ratios with 95 % confidence intervals for the identified trajectory patterns. RESULTS: Participation in any groups was significantly less likely to belong to "Accelerated disability" (OR=0.74 [95 % CIs 0.60-0.92]), "Persistently mild disability" (0.68 [0.55-0.84]), and "Persistently severe disability" (0.67 [0.50-0.83]) compared to "Minimum disability." Although participation in horizontal groups was similarly associated with trajectories regardless of gender, vertical groups was not associated with trajectories among males. CONCLUSIONS: Social participation among older adults may be associated with an extended period of living without disabilities before death. This association may differ by gender and social participation group and requires further research.

Measuring functional ability in Healthy Ageing: testing its validity using Japanese nationwide longitudinal data.

BACKGROUND: The United Nations Decade of Healthy Ageing 2021-2030 suggests nations should monitor functional ability as an indicator of healthy ageing progress. Functional ability is the attribute of people to do something they value and consists of five domains. We examined its validity in terms of a construct, cross-validation across multiple waves' data, and predictivity for subsequent well-being. METHODS: Using panel data from 35,093 community-dwelling adults aged ≥65 years from the Japan Gerontological Evaluation Study, we performed factor analyses to explore the construct of functional ability domains in both 2013 and 2016. A modified Poisson regression analysis was employed to test their associations with well-being (subjective health and happiness) in 2019. RESULTS: The mean age (standard deviation) of participants was 72.1 (5.0) years, and 52.0% were women. A total of 85.0% reported good subjective health, and 50.6% reported high happiness levels. Factor analyses with 31 logically checked candidate items from 2016 data suggested a three-factor model comprising 24 items, which were compatible with the 2013 data results. Based on the World Health Organization's original domains, we named domains as domain #1: ability to build and maintain relationships; domain #2: ability to meet basic needs + ability to move around and domain #3: ability to learn, grow and make decisions + ability to contribute. All three domains predicted both subjective health and happiness in 2019. CONCLUSIONS: Empirical data from Japan supports the functional ability concept among older individuals. Validating this concept with data from other nations is warranted.

Does disaster-related relocation impact mental health via changes in group participation among older adults? Causal mediation analysis of a pre-post disaster study of the 2016 Kumamoto earthquake.

BACKGROUND: Disaster-related relocation is associated with depression and post-traumatic stress disorder, especially in older adults. Disaster-related relocation often deprives survivors of opportunities for social group participation, potentially deteriorating their mental health. On the contrary, the relocation could also be an opportunity for optimizing social relationships, ending/reducing unwanted participation. This study examined the potential mediation effects of changing participation for the link of disaster-related relocation to mental health. METHODS: We analyzed a pre-post disaster dataset of functionally independent older adults from the Japan Gerontological Evaluation Study. Following the 2013 survey, a follow-up survey was conducted seven months after the 2016 Kumamoto earthquake (n = 828). RESULTS: The causal mediation analyses indicated that compared to no relocation, the relative risk for experiencing major depressive episodes among those relocating to temporary housing was 3.79 [95% confidence interval: 1.70-6.64] (natural direct effect). By contrast, the relative risk for those renewing (either ceased or started) group participation was 0.60 [95% CI: 0.34-0.94] (natural indirect effect). CONCLUSIONS: Optimization of social ties according to a renewal of group participation status might have protected older adults in temporary housing against depression.

Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial.

BACKGROUND: Although many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available. METHODS: This study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status. RESULTS: Most women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48-0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status. CONCLUSIONS: Local government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings. TRIAL REGISTRATION: UMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.

Social Isolation and Depressive Symptoms Among Older Adults: A Multiple Bias Analysis Using a Longitudinal Study in Japan.

PURPOSE: Despite the potential burden of social isolation on mental health, it is unclear which component of social isolation (living alone, lack of social support, and lack of social participation) is mostly associated with depression among older adults and whether it varies by gender. Moreover, previous observational studies have suffered from several systematic biases such as confounding, misclassification, and selection bias. We thus aimed to investigate the risk of social isolation on subsequent depressive symptoms among older men and women, fully taking account of such systematic biases simultaneously. METHODS: This study included 15,311 adults from a nationwide longitudinal cohort study of older adults aged ≥65 years in Japan. We employed modified Poisson regression models to estimate the adjusted risk ratio (aRR) of elevated depressive symptoms (the Geriatric Depression Scale: ≥5 vs. <5) in 2016 according to the social isolation index (SII) score (0-5 points) in 2013. Non-probabilistic multiple bias analyses with weighting approach and bounding factor were conducted to adjust for possible confounding, exposure misclassification, and selection biases. RESULTS: The mean age (SD) of participants was 72.1 (4.9) years. Adults with the SII score ≥2 showed an increased risk of elevated depressive symptoms than those with the SII score <2 (aRR [95% CI] = 1.57 [1.41-1.76]). All components of SII were associated with elevated depressive symptoms except living alone for women. Our multiple bias analysis showed that an unmeasured confounder needed to have at least moderate relationship (RR=2.0-3.0) with both exposure and outcome to explain away the observed association particularly when social isolation status was independently and non-differentially misclassified. CONCLUSION: Among older adults in Japan, social isolation was associated with an increased risk of elevated depressive symptoms, even after taking account of systematic biases simultaneously. Increasing social connection may mitigate the risk of depression, which should be the subject of future research.

A report of the social determinants of health workshop: Muddle cleared up in a polylogue.

This letter illustrated our online workshop about clinical practice and postgraduate education about social determinants of health (SDH) to family medicine residents and attending physicians in Japan. The participants were encouraged not only by acquiring knowledge and skills but by sharing their experience and talking reflectively. The opportunities for family physicians in Japan to learn about SDH and reflect on their practices should be warranted.

Functional disability trajectories at the end of life among Japanese older adults: findings from the Japan Gerontological Evaluation Study (JAGES).

BACKGROUND: this study aimed to identify distinct subgroups of trajectories of disability over time before 3 years of death and examine the factors associated with trajectory group membership probabilities among community-dwelling Japanese older adults aged 65 years and above. METHODS: participants included 4,875 decedents from among community-dwelling Japanese older adults, aged ≥ 65 years at baseline (men: 3,020; women: 1,855). The certified long-term care levels of the national long-term care insurance (LTCI) system were used as an index of functional disability. We combined data from the 2010 Japan Gerontological Evaluation Study and data from the 2010 to 2016 LTCI system. Group-based mixture models and multinominal logistic regression models were used for data analysis. RESULTS: five distinct trajectories of functional disability in the last 3 years of life were identified: 'persistently severe disability' (10.3%), 'persistently mild disability' (13.0%), 'accelerated disability' (12.6%), 'catastrophic disability' (18.8%) and 'minimum disability' (45.2%). Multinominal logistic regression analysis found several factors associated with trajectory membership; self-rated health was a common predictor regardless of age and gender. The analysis also showed a paradoxical association; higher education was associated with trajectory group membership probabilities of more severe functional decline in men over 85 years at death. CONCLUSIONS: individual perception of health was a strong predictor of trajectories, independent of demographic factors and socio-economic status. Our findings contribute to the development of policies for the long-term care system, particularly for end-of-life care, in Asian countries.

A novel behavioral science-based health checkup program and subsequent metabolic risk reductions in a workplace: Checkup championship.

The effectiveness of general health checkups and lifestyle counseling has been questioned. This study examined whether a workplace health promotion program implemented during a health checkup was associated with metabolic syndrome-related indicators. Hakuhodo DY group, one of Japan's largest advertising agencies, implemented a behavioral science-based program called "Checkup Championship" (Kenshin-sen in Japanese) in 2019, in which all employees could voluntarily participate. We studied 3697 employees (2818 men and 879 women, mean age: 40.7 years), consisting of 1509 program participants and 2188 non-participants. The characteristics of participants and non-participants were balanced using inverse probability weighting. We used their data from the health checkups in 2018 and 2019 together with other covariates and performed a difference-in-differences analysis using a linear mixed model. After program implementation, greater reductions were observed among participants compared with non-participants in weight (-0.66 kg, 95% confidence interval: -0.84 to -0.47), body mass index (-0.23 kg/m2, -0.29 to -0.16), waist circumference (-0.67 cm, -0.91 to -0.43), systolic blood pressure (-1.13 mmHg, -2.10 to -0.16), and diastolic blood pressure (-0.84 mmHg, -1.53 to -0.15). In addition, we observed greater reductions in weight, body mass index, waist circumference, and low-density lipoprotein cholesterol among participants who were with two or more risk factors for metabolic syndrome than other participants. We found that participation in a health checkup program based on behavioral science was associated with reduced metabolic syndrome-related indicators. There may be room for improvement in the effectiveness of general health checkups.

[Childhood experiences of seeking parental support, social interactions, and interpersonal relationships in adulthood: a cross-sectional study].

Objectives　Some young adults often tend to perceive interpersonal relationships and social interactions as stressful, and as such, avoid them. Seeking help from parents and interactions with neighbors during childhood are known to be important in forming positive impressions of people, thereby influencing help-seeking behavior in adulthood. However, it remains unclear how these experiences are related and how they influence interpersonal relationships in adulthood. This study aimed to investigate whether childhood experience(s) of social interactions in the community has any modifying effect on the association between seeking support from parents in childhood and avoidance of interpersonal relationships in adulthood.Methods　Data pertaining to 1,274 individuals (aged 18 to 39 years) were collected from a questionnaire survey conducted in 2018 by Nagoya City of Japan. Modified Poisson regression analyses were performed to estimate the prevalence ratio of current avoidance of interpersonal relationships depending on the experience(s) of seeking help from a parent (father/mother analyzed respectively) and participating in community events in childhood. Data were stratified according to gender, and adjusted for age, parents' educational background, mother's working status in childhood, subjective recognition of economic status in childhood and seeking help from the other parent. Effect estimates were calculated to evaluate the existence of any modifying effect.Results　No modifying effect of participating in community events in childhood was seen in the association between experience of seeking help from the father and current avoidance of interpersonal relationships, in either gender. Regarding experience of seeking help from the mother, a modifying effect was seen in men. Among men who had sought help from their mother, those who had participated in community events were less likely to avoid interpersonal relationships in adulthood.Conclusion　In order to reduce the tendency to avoid interpersonal relationships in adulthood, childhood experiences of seeking help from the mother and participating in community events may be important, particularly for men. In addition to appropriate parental support, promoting interactive events for children in communities may mitigate the problem of poor social skills later in life.

[The concept of social determinants of health in health promotion policies in Thailand, Sweden, England, USA, and Japan: A narrative review].

Objectives　The Commission on Social Determinants of Health (CSDH) of the World Health Organization (WHO) recommends that national and municipal governments take adequate steps to "improve daily living conditions," "(create governance to) tackle the inequitable distribution of power, money, and resources," and "measure and understand the problem and assess the impact of" government actions. This study provides an analysis of the health promotion policies of Japan and other countries and examines their conformance to these recommendations, and offers suggestions for developing a conducive social environment for Japan's health promotion policies.Methods　We reviewed grey literature on health promotion policies in Japan, the USA, England, Sweden, and Thailand, extracting the definitions of health inequalities and their characterization in each policy, and analyzing each document vis-á-vis the CSDH's three recommendations and "comprehensive national health equity surveillance framework."Results　The health promotion policies of Japan, England, Sweden, and the USA had similar definitions of health inequality, emphasizing fairness and prioritizing the reduction of health inequality as the key strategy for health promotion. However, their primary approaches to improve daily living conditions varied: In Japan, the primary approach is to create opportunities for participation and ensure access to social resources. Meanwhile, the USA relies largely on objective assessments and scientific evidence-based actions. England focused on enhancing support for socially disadvantaged individuals and areas. In Sweden, a universal intervention based on life-course perspectives was stressed, while Thailand attached much value to a multi-sectoral collaboration. All these countries, however, had a health policy implementation plan in quest of the elimination of unfair distributions of power, money, and resources. The USA planned to monitor a total of 187 social factors, the largest number among the 6 subject countries. It also had a wide range of perspectives on health inequalities, including income and disability, as well as conducting assessments using information from outside the health sector, with items assessed at various levels, including individual, regional, and national policies.Conclusion　With reference to these approaches in other countries, for Japan's health promotion policies, we recommend: (1) grasping of health inequalities from more diversified perspectives and adopting measures to address them, (2) setting targets based on multi-level social determinants of individual behavior and health status, including individual socioeconomic status, and (3) promoting collaborative initiatives and use of indicators with entities outside the health sector.

Public assistance program and depressive symptoms of the recipient: a cross-sectional Japan Gerontological Evaluation Study.

BACKGROUND: Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have higher risks of morbidity than non-recipients, and mental health is strongly related to frailty. We aimed to examine whether older recipients of public assistance were more likely to have depressive symptoms compared to non-recipients. METHODS: Data were obtained from the Japan Gerontological Evaluation Study, a 2016 community-based study of older adults. Poisson regression analyses with a robust error variance using fixed effects were conducted to examine the relationship between receiving public assistance and depressive symptoms controlling for sociodemographic factors. Depressive symptoms were assessed by the Geriatric Depression Scale 15. RESULTS: We found that the older recipients of public assistance were 1.57 times (95% confidence interval [CI]: 1.47, 1.67) more likely to have depressive symptoms compared to non-recipients. We also found that, when additionally adjusting for indicators of social participation, this relationship was slightly attenuated; however, the recipients still had worse mental health issues (Prevalence ratio: 1.33; 95% CI: 1.25, 1.42). CONCLUSIONS: Even after controlling for sociodemographic factors, older recipients of public assistance tended to be more depressed than non-recipients. However, our findings also indicated that social participation could slightly attenuate the negative relationship between receiving public assistance and depressive symptoms. Therefore, the public assistance program needs to consider the inclusion of mental healthcare support in addition to financial support.

Effectiveness of a community organizing intervention on mortality and its equity among older residents in Japan: A JAGES quasi-experimental study.

Interventions that involve key aspects of community organizing, such as quantitative community assessments and organizational partnership support for the community, may promote residents' health. We evaluated the effectiveness of this form of intervention on mortality and its variability across individual-level household equivalized income tertiles, comparing 52,858 residents aged 65 and above in 12 intervention municipalities to 39,006 residents in nine control municipalities in Japan. During 1,166 days of follow-up, the adjusted hazard ratio for cumulative mortality among men in the intervention municipalities was 0.92 (95% confidence interval: 0.86, 0.99) compared to those in the control group, with similar results being observed across all income levels. Active utilization of data to evaluate communities and building intersectoral partnerships might lower older male residents' mortality risk, regardless of their income status.

Leisure activities and instrumental activities of daily living: A 3-year cohort study from the Japan Gerontological Evaluation Study.

AIM: We prospectively examined the association between leisure activities and changes in instrumental activities of daily living (IADL) among participants of the Japan Gerontological Evaluation Study (JAGES). METHODS: We analyzed data collected from 49 732 JAGES participants (23 359 men and 26 373 women), aged ≥65 years, from 24 municipalities in Japan. MEASUREMENTS: Baseline data were obtained for 25 types of leisure activities in which the cohort members participated. Baseline (2010) and follow-up (2013) data on IADL were collected - the outcome indicated changes in IADL scores from 2010 to 2013. We regressed changes in IADL scores from the 2010 to 2013 to the number of leisure activities. RESULTS: Older adults who engaged in more leisure activities had higher changes in IADL scores than those who engaged in fewer leisure activities: the ß values (95% confidence interval [CI]) of the IADL scores were 0.001 [-0.04-0.04], 0.04 [0.01-0.08], 0.09 [0.05-0.13], 0.09 [0.05-0.14], 0.08 [0.02-0.13], and 0.13 [0.07-0.18] for having one, two, three, four, five, and more than six types of leisure activities (P for trend <0.001), respectively. Similar associations were found for different types of leisure activities, including predominantly physical and cultural activities. Statistically significant linear trends were obtained among the group, solitary, and other leisure activity subgroups (P for trend <0.05). CONCLUSIONS: Encouraging engagement in leisure activities may promote maintenance of IADL among older populations. Different types of leisure activities appear to have similar positive impacts on IADL. Geriatr Gerontol Int 2022; 22: 152-159.

Predictors of home being the preferred place of death among Japanese older people: JAGES cross-sectional study.

AIM: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people. METHODS: Cross-sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death. RESULTS: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end-of-life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end-of-life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area. CONCLUSIONS: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345-352.

Factors Associated With Discussions Regarding Place of Death Preferences Among Older Japanese: A JAGES Cross-Sectional Study.

In Japan, many adults prefer to die at home; however, few have their preferences actually come true. While discussions regarding place of death preferences (DPDPs) are important for older adults, they are poorly documented. Therefore, we investigated the factors associated with older Japanese men and women having DPDPs. We used cross-sectional survey data collected for the Japan Gerontological Evaluation Study (JAGES). We applied multivariable logistic regression analysis to calculate the odds ratio (ORs) of having DPDPs separately between men (n = 2,770) and women (n = 3,038) aged ≥ 75 years. We considered 17 potential factors associated with having DPDPs, which were classified as either demographic, healthcare, family, or community factors. Among participants, 50.1% had DPDPs: 1,288 men (44.3%) and 1,619 women (55.7%). Older adults, DPDPs were associated with 5 additional factors; e.g. having a primary care physician (ORs = 1.47 [men] and 1.45 [women]), as were those who gave family and friends advice (ORs = 1.26 [men] and 1.62 [women]), and having people who listened to their concerns (ORs = 1.70 [men] and 1.81 [women]). Among men, DPDPs were associated with 3 additional factors; e.g. humorous conversations with their spouse (OR = 1.60). Among women, only one factor-reading newspapers (OR = 1.43) was associated with having DPDPs. Social networks with primary care physicians, family members, and friends may be important factors in promoting DPDPs. These gender-based differences in older adults relating to DPDPs should be considered when developing interventions to promote advance care planning that includes DPDPs.

Social participation patterns and the incidence of functional disability: The Japan Gerontological Evaluation Study.

AIM: To examine whether patterns of social participation vary in their associations with functional disability. METHODS: Data from 44 978 participants (22 750 men and 22 228 women) who participated in the 2010 Japan Gerontological Evaluation Study were analyzed; a study of those aged ≥65 years from 23 municipalities in eight prefectures. Social participation information was obtained at baseline with an eight-item questionnaire. Incidence of functional disability from 2010 to 2013 was defined as a new certification of eligibility for municipal public long-term care insurance. Social participation patterns were analyzed using exploratory factor analysis and participants were classified into quartiles of factor scores of social participation patterns. A competing risk model was used to calculate the hazard ratios and 95% confidence intervals for the incidence of functional disability in 3 years of follow-up. RESULTS: Two social patterns were identified: sports groups/clubs and hobby groups, and political groups/organizations and industry/trade associations. For both patterns, compared with participants in the lowest quartile, participants in the highest quartile were more likely to be male, college educated, high-income and current drinkers. Both patterns were associated with reduced incidence of functional disability (adjusted hazard ratios for top quartile of sports and hobby pattern: 0.66, 95% confidence interval: 0.59, 0.74; for political and industry/trade pattern: 0.81, 95% confidence interval: 0.72, 0.90; P for trend <0.001 for both). CONCLUSIONS: Those whose social participation patterns were characterized by frequent participation in sports groups/clubs and hobby groups or political groups/organizations and industry/trade associations were less likely to develop a functional disability. Geriatr Gerontol Int 2020; 20: 765-772.

Postdisaster Changes in Social Capital and Mental Health: A Natural Experiment From the 2016 Kumamoto Earthquake.

Levels of social capital can change after a natural disaster; thus far, no study has examined how changes in social capital affect the mental health of disaster victims. In this study, we examined how predisaster social capital and its changes after a disaster were associated with the onset of mental disorders. In October 2013, we mailed a questionnaire to participants in the Japan Gerontological Evaluation Study living in Mifune, a town in Kumamoto Prefecture, Japan, and measured predisaster social capital. In April 2016, the Kumamoto earthquake struck the region. Three years after the baseline survey, postdisaster social capital and symptoms of mental disorders were measured using the Screening Questionnaire for Disaster Mental Health (n = 828). Multiple Poisson regression indicated that a 1-standard-deviation change in predisaster social cohesion at the community level reduced the risk of depression among women (relative risk = 0.44, 95% confidence interval: 0.24, 0.78); a decline in social capital after the disaster elevated the risk (relative risk = 2.44, 95% confidence interval: 1.33, 4.47). In contrast to social cohesion, high levels of social participation at the community level were positively associated with the risk of depression among women. Policy-makers should pay attention to sex differences and types of social capital when leveraging social capital for recovery from disasters.

Effectiveness of community organizing interventions on social activities among older residents in Japan: A JAGES quasi-experimental study.

Social activities in the community help older adults maintain functional ability. Community organizing, based on the assessment of health risks, community assets, and fostering intersectoral organizational partnerships, could increase participation opportunities. Supporting municipality staff members in building their capacity to take those actions might benefit them. Nevertheless, the effectiveness of such support remains unclear. This real-world-setting study evaluated the effectiveness of providing support for municipality health sectors in relation to older residents' social activities. Based on the Japan Gerontological Evaluation Study (JAGES), a nationwide study of community-dwelling older adults, from 2013 to 2016 researchers collaborated with health sector staff members in 13 participating municipalities (intervention group) in utilizing the JAGES-based community assessment data and building organizational partnerships. The remaining 12 municipalities (control) obtained the data only. We analyzed the longitudinal data of 47,106 older residents, performing a difference-in-differences (DID) analysis, weighted by the inverse of propensity to be selected for the intervention group, allowing for a multilevel (municipality/individual) data structure. In the intervention group, the estimated group participation prevalence in men increased by 10.4 percentage points from 47.5% to 57.9%, while in the control group, participation increased by 7.9 percentage points from 47.2% to 55.0% (DID estimated = 0.025, P = 0.011). No statistically significant difference between the two groups was observed among women (P = 0.131). Support for community organizing may improve group participation among older male residents. The community-attributable impact could be large, given that the intervention has the potential to work for all older residents in the municipality.

Community-based care for healthy ageing: lessons from Japan.

PROBLEM: The measures for long-term care prevention that the Japanese government had introduced in 2006 were unsuccessful because of the failures to identify high-risk individuals and to enrol enough participants in the community prevention programme. APPROACH: The Japanese government shifted its primary strategy from a high-risk strategy to a community-based population strategy in 2015, by reforming the Long-term Care Insurance Act. This act is focusing on community-based care and social determinants of health. The Act and the government's plans for long-term care prevention are inspired by a social participation intervention called ikoino saron, that is gathering salons for people older than 65 years. These salons, managed by local volunteers, are held once or twice a month in communal spaces within walking distance of community members' homes and have a low participation fee. At the gatherings, older people can meet and interact with others through enjoyable, relaxing and sometimes educational programmes. LOCAL SETTING: Japan has the world's largest ageing population, with 27.7% (35.2 million/126.7 million) of people older than 65 years. RELEVANT CHANGES: Studies have shown that participation in the salons was associated with a halved incidence in long-term care needs and about one-third reduction in the risk of dementia onset. Evidence also suggests that financially vulnerable older adults were more likely to participate in such interventions. In 2017, 86.5% (1506/1741) of the Japanese municipalities had implemented the salons. LESSONS LEARNT: Integrated care for long-term care prevention should consider interventions targeting the whole community in addition to high-risk individuals.

Social Capital and the Improvement in Functional Ability among Older People in Japan: A Multilevel Survival Analysis Using JAGES Data.

We investigated the contextual effects of community social capital on functional ability among older people with functional disability in Japan, and the cross-level interaction effects between community social capital and individual psychosocial characteristics. We used data from the Japan Gerontological Evaluation Study for 1936 men and 2207 women nested within 320 communities and followed for 46 months. We used objective data for functional ability trajectories derived from the national long-term care-insurance system, and a validated measure of health-related community social capital comprising three components: civic participation, social cohesion, and reciprocity. A multilevel survival analysis with a community-level random intercept showed that in communities with high civic participation, women who actively participated in any community group showed greater functional ability improvement than did women who did not participate (pinteraction = 0.05). In communities with high social cohesion, older men who perceived that their communities' social cohesion was high showed greater functional ability improvement than men who perceived it to be low (pinteraction = 0.02). Community social capital can thus affect functional ability improvements variously, depending on individual psychosocial characteristics and gender. Community interventions aiming to foster social capital should focus on people who are excluded from existing opportunities to participate.