Underlying medical conditions and anti-SARS-CoV-2 spike IgG antibody titers after two doses of BNT162b2 vaccination: A cross-sectional study

Patients with underlying medical conditions are at high risk of developing serious symptoms of the coronavirus disease 2019 than healthy individuals; therefore, it is necessary to evaluate the immune response to vaccination among them to formulate precision and personalized vaccination strategies. However, inconsistent evidence exists regarding whether patients with underlying medical conditions have lower anti-SARS-CoV-2 spike IgG antibody titers. We performed a cross-sectional study enrolling 2762 healthcare workers who received second doses of BNT162b2 vaccination from three medical and research institutes between June and July, 2021. Medical conditions were surveyed by a questionnaire, and spike IgG antibody titers were measured with chemiluminescent enzyme immunoassay using serum collected on the median of 62 days after the second vaccination. Multilevel linear regression model was used to estimate geometric mean and ratio of mean (95% confidence interval, CI) for the presence and absence of medical conditions and treatments. Among all participants (median age, 40 years [interquartile range, 30-50]; male proportion, 29.4%), the prevalence of hypertension, diabetes, chronic lung disease, cardiovascular disease, and cancer was 7.5%, 2.3%, 3.8%, 1.8%, and 1.3%, respectively. Patients with treated hypertension had lower antibody titers than those without hypertension; the multivariable-adjusted ratio of mean (95% CI) was 0.86 (0.76-0.98). Patients with untreated and treated diabetes had lower antibody titers than those without diabetes; the multivariable-adjusted ratio of mean (95% CI) was 0.63 (0.42-0.95) and 0.77 (0.63-0.95), respectively. No substantial difference was observed between the presence or absence of chronic lung disease, cardiovascular disease, or cancer. Patients with untreated hypertension and patients with untreated and treated diabetes had lower spike IgG antibody titers than participants without those medical conditions, suggesting that continuous monitoring of antibody titers and further booster shots could be necessary to maintain adaptive immunity in patients with hypertension or diabetes.

The Relationship Between Social Interaction and Anxiety Regarding COVID-19 in Japanese Older Adults

While previous studies suggest that women have higher anxiety than men regarding COVID-19, underlying mechanisms remain unclear. This study tries to explain the mechanisms by gender difference in social interaction based on a theory of social amplification of risk framework (SARF). We surveyed older adults in Japan regarding their anxiety regarding COVID-19, as well as the frequencies of their direct and indirect social interaction in July 2020 (N = 1,587, aged 78-99 years). To explore the way in which gender and anxiety regarding COVID-19 were mediated by these two types of social interactions, MODEL4 of SPSS's Process MACRO was applied to the data. We found that older women interacted more directly and indirectly with others than did older men. And, direct social interaction was negatively and related, but indirect social interaction was positively related to older adults' anxiety regarding COVID-19. Furthermore, direct social interaction was related to older women's low anxiety regarding COVID-19, whereas indirect social interaction was related to older women's high anxiety regarding COVID-19. The findings of our study suggest that the degree of anxiety regarding COVID-19 among older women may be dependent upon the types of social interaction they have with others.

CHANGES IN LIFE SATISFACTION DURING THE FIRST YEAR OF THE COVID-19 PANDEMIC: A LONGITUDINAL STUDY OF JAPANESE ADULTS

The outbreak of the novel coronavirus (COVID-19) has exerted a major impact on daily life. Despite older adults being at a higher risk of severe illness from COVID-19, research has indicated that older adults experienced the same or even higher levels of well-being during the early phase of the pandemic than younger adults. To investigate adverse long-term effects, we examined how individuals’ well-being changed during the first year of the pandemic. A total of 5,281 Japanese adults aged 15—89 years participated in an online survey in February 2020 (before the first state of emergency) and were followed up in March 2021 (during the second state of emergency; follow-up rate 54.7%). Well-being was assessed as a one-item indicator of life satisfaction, with a range of 0－10. Counterintuitively, results of a latent change score model demonstrated that life satisfaction increased over time (unstandardized coefficient of 1.17, SE = 0.16, standardized coefficient of 0.58). Individuals aged 64 years and below, with low levels of education, living alone, and perceiving worse health and economic status showed less increase in life satisfaction. In an additional analysis, those more concerned about the pandemic at follow-up displayed less increase. The findings suggest that most people did not exhibit a decrease in life satisfaction during the first year of the COVID-19 pandemic. However, certain individuals could be vulnerable to the outbreak due to the lack of resources. Researchers should better understand the factors that drive the resilience of older adults in the face of adversity.

INVOLVEMENT IN CARE DECISION-MAKING AND ADVERSE OUTCOME ONSET IN COMMUNITY-DWELLING CARE RECIPIENTS IN JAPAN

The involvement of older adults in care decision-making may enhance their daily life motivation and quality of life. Furthermore, it could contribute to their better prognosis in long-term care. We examined the association between decision-making involvement and the onset of adverse outcomes, such as institutionalization and death, among older adults under long-term care. This study used two-year longitudinal survey data of Japanese community-dwelling care recipients aged 65 and above. The participants were followed regarding the onset of institutionalization and deaths. The status of involvement in decision-making was assessed based on one item and the selection among the following response options: “very much involved,” “fairly involved,” “not very involved,” “never involved,” “unclarified wishes,” and “absence of person supporting decision-making.” A multivariable logistic regression analysis estimated the odds ratios (OR) and 95% confidence intervals (CI) for the onset of adverse outcomes, composite of institutionalization and death. A total of 707 participants with no severe cognition disabilities (MMSE>12) and no missing variables at the baseline were included and responded to the follow-up survey. At the baseline, 36.5% reported being very much involved in decision-making. The onset of adverse outcomes was observed in 17.5% of participants (institutionalization, 5.1%; death, 12.4%). Compared to those with very high involvement in decision making, those who were not involved were more likely to have adverse events, even after adjusting for covariates (OR=2.86 [95% CI: 1.21-6.76], p=0.016). Our findings show the importance of decision-making involvement in daily care regarding better prognoses in long-term care.

INTERACTIONS WITH PEOPLE WITH DEMENTIA, LEARNING EXPERIENCES, AND PUBLIC STIGMA AGAINST DEMENTIA

Overcoming stigma around dementia is a global challenge. This cross-sectional study examined the association of experiences of interacting with people with dementia (PwD) and learning about dementia, with the public-stigma against dementia. We recruited—via an internet survey—710 Japanese adults (mean age = 46.3 years; 49.3% females) without any medical or welfare license, or dementia-related work experience. Public-stigma against dementia was assessed using the Japanese version of Phillipson et al.’s scale (2012) exploring dementia-related attitudes in the context of “personal avoidance,” “person centeredness,” “fear of labeling,” and “fear of discrimination.” Multivariable linear regression analysis was employed to examine the association of interacting with PwD and learning regarding dementia as explanatory variables with dementia stigma score, adjusting for sociodemographic variables. Regarding interactions with PwD, talking or activities with PwD were associated with low “personal avoidance” (β = -1.47, p = 0.002), “fear of labeling” (β = -0.96, p = 0.020), and “fear of discrimination” (β = -0.396, p = 0.043). Experiences of living with PwD were associated with low “personal avoidance” (β = -2.35, p = 0.002) and “fear of discrimination” (β = -0.789, p = 0.013). Learning experiences at school regarding dementia were associated with low “personal avoidance” (β = -4.01, p < 0.001), and self-learning experiences were associated with low “personal avoidance” (β = -1.73, p = 0.049) and high “person centeredness” (β = 1.27, p = 0.037). However, workplace learning was not associated with any area. Interacting with PwD and learning about dementia might reduce associated public-stigma.

The role of social resources and trajectories of functional health following stroke

Stroke is a major cause of disability in old age. Research has revealed that social resources available after the onset of stroke can mitigate functional prognosis. However, most studies have conceptualized resources as static rather than dynamic and have not measured changes in social resources from the pre-to post-stroke periods. To better understand the recovery process following stroke, we examined how social resources available before its onset and changes from pre-to post-stroke were associated with trajectories of functional health following stroke. Data were derived from an up to 19-year longitudinal study of a nationally representative sample of Japanese adults aged 60 years and older. We identified 389 people who experienced self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 75.9, SD = 6.8; 49.1% women). The average number of observations was 4.6 (SD = 1.6, range 2-7). Functional health was measured with self- or proxy-reported basic and instrumental activities of daily living. Social resources were indexed as residential status, contact with own non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, sex, education, health condition, and cognitive function. A multiphase growth model indicated that individuals who participated more frequently in social groups prior to stroke exhibited less functional deterioration post-stroke than those who participated less frequently. Whereas contact frequency with non-coresident children typically declined following stroke, the analysis further revealed that individuals who maintained contact frequency from pre-to post-stroke showed less steep functional decline over time in the post-stroke period despite minor individual differences. We found that social resources before stroke onset and changes in the resources following stroke may play a protective role against adverse prognoses. Inclusive communities may help older adults remain independent even after serious health events.

Construct Validity of a New Health Assessment Questionnaire for the National Screening Program of Older Adults in Japan: The SONIC Study

The Japanese government has implemented a new screening program to promote measures to avoid worsening lifestyle-related diseases and frailty among the older population. In this effort, the government formulated a new health assessment questionnaire for the screening program of old-old adults aged ≥75 years. The questionnaire comprises 15 items, of which 12 address frailty, two address general health status, and one addresses smoking habits. This study examined the construct validity of this questionnaire, using the explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The data used in this study were drawn from a mail-in survey conducted in 2020 as part of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A total of 1576 respondents (range, 78-99 years of age) were included in the study. Although the EFA did not show an interpretable factor structure of the questionnaire with 15 items, the CFA using only 12 frailty-related items showed the goodness of fit for a higher-order factor "frailty", and the five frailty-related sub-factors model was acceptable. These results suggest that the total score of the 12 frailty-related items in the questionnaire can be used as an indicator of the degree of "frailty".

Establishment of the Japanese version of the dementia stigma assessment scale

Aim

Reducing stigma against dementia is a global challenge, but the assessment scale is not well established. We examined the validity and reliability of the Japanese version of the assessment scale of public stigma against dementia.

Methods

This study recruited 819 adults aged 20–69 years (mean age = 45.9 years; 52.0% females) through an internet survey, and 34 community‐dwelling adults aged 20–78 years (mean age = 45.8 years; 55.9% females). Participants completed the Japanese version of the assessment scale of dementia stigma developed by Phillipson et al., with forward and back translations. In the internet survey sample, exploratory factor analysis was performed to verify factorial validity, and correlations with ageism and dementia attitudes were examined to test the concurrent validity. In the community sample, test–retest reliability was evaluated using intraclass correlation coefficients (ICCs) between two responses with a two‐week interval.

Results

Factor analysis revealed a four‐factor structure: “personal avoidance,” “fear of labeling,” “person centeredness,” and “fear of discrimination” (Cronbach's α = 0.892, 0.840, 0.879, 0.829, respectively). Personal avoidance, fear of labeling, and fear of discrimination were positively correlated with ageism (r = 0.598, 0.214, 0.369) and negatively correlated with dementia attitudes (r = −0.745, −0.453, −0.475); person centeredness was inversely correlated with ageism (r = −0.322), but positively correlated with dementia attitudes (r = 0.537), showing good concurrent validity. The scale showed acceptable test–retest reliability (ICCs = 0.67–0.80).

Conclusions

The Japanese version of the assessment scale of public stigma against dementia was established with good concurrent validity and adequate reliability. Geriatr Gerontol Int 2022; 22: 790–796.

Pathophysiological Analysis of Uninephrectomized db/db Mice as a Model of Severe Diabetic Kidney Disease

Diabetic nephropathy, included in diabetic kidney disease (DKD), is the primary disease leading to end-stage renal disease (ESRD) or dialysis treatment, accounting for more than 40% of all patients with ESRD or receiving dialysis. Developing new therapeutics to prevent the transition to ESRD or dialysis treatment requires an understanding of the pathophysiology of DKD and an appropriate animal model for drug efficacy studies. In this study, we investigated the pathophysiology of diabetic kidney disease with type 2 diabetes in uninephrectomized db/db mice. In addition, the nephrectomized db/db mice from 10 weeks to 42 weeks were used to assess the efficacy of long-term administration of the angiotensin-II–receptor antagonist losartan. The blood and urinary biochemical parameters and the blood pressure which is a main pharmacological endpoint of the losartan therapy, were periodically measured. And at the end, histopathological analysis was performed. Uninephrectomized db/db mice clearly developed obesity and hyperglycemia from young age. Furthermore, they showed renal pathophysiological changes, such as increased urinary albumin-creatinine ratio (UACR) (the peak value 3104±986 in 40-week-old mice), glomerular hypertrophy and increased fibrotic areas in the tubulointerstitial tubules. The blood pressure in the losartan group was significantly low compared to the normotensive Vehicle group. However, as expected, Losartan suppressed the increase in UACR (829±500) indicating the medication was sufficient, but the histopathological abnormalities including tubular interstitial fibrosis did not improve. These results suggest that the uninephrectomized db/db mice are useful as an animal model of the severe DKD indicated by the comparison of the efficacy of losartan in this model with the efficacy of losartan in clinical practice.

Typology of Work-Family Balance Among Middle-Aged and Older Japanese Adults

This study explores the clusters of work-family balance (WFB) among Japanese middle-aged and older adults and clarifies the characteristics of the derived clusters. Data on working adults (N = 1,351; age range = 40-85 years) were drawn from a pool of participants in the National Institute for Longevity Sciences-Longitudinal Study of Aging. The WFB scale consists of subscales assessing work-family conflict (WFC) and work-family facilitation (WFF). First, a cluster analysis was performed using the WFB scale, and four clusters were extracted. Second, we examined associations between the four clusters and related variables such as demographic characteristics, work, family, and lifestyle factors, social support, and mental health. Our findings showed that the clusters included high-WFC/high-WFF, high-WFC/low-WFF, low-WFC/high-WFF, and low-WFC/low-WFF. Differences were found in related variables among the clusters. Specifically, those in the Low-WFC/High-WFF cluster had a good lifestyle, received the highest levels of social support, and had the fewest mental health issues. Our findings have implications for maintaining sufficient WFB and promoting positive mental health among workers.

Art and cultural activity engagement and depressive symptom onset among older adults: A longitudinal study from the Japanese Gerontological Evaluation Study

OBJECTIVES

Art and cultural activities can benefit mental health. However, there is insufficient evidence on active engagement in art and cultural activities for preventing depressive symptoms among older adults. Therefore, we examined the association of active engagement in art and cultural activities with depressive symptom onset among older adults using 3-year longitudinal data.

METHODS

This longitudinal study recruited non-institutionalised older adults independent in daily living from the Japan Gerontological Evaluation Study (JAGES) established in 2010, and those without depressive symptoms were followed for three years. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. Active engagement in nine art and cultural activities, including Japanese traditional cultural activities, were evaluated (musical performance, singing, dancing, handicrafts, painting, photography, poetry composition, calligraphy, and tea ceremony/flower arrangement).

RESULTS

Ultimately, 37,627 older adults without depressive symptoms at baseline were analysed. The participants' mean age (standard deviation) was 72.6 (5.5) years, and 51.5% were female. During the follow-up period, depressive symptoms occurred in 3844 participants (10.2%). Multivariable logistic regression analysis revealed that active engagement in art and cultural activities was inversely associated with depressive symptom onset (odds ratio = 0.80, 95% confidence interval = 0.73-0.87, p < 0.001). This association was confirmed regardless of age, gender, and socioeconomic status. Among the activities, especially dancing and photography were protective against depressive symptoms.

CONCLUSION

Active engagement in art and cultural activities may contribute to preventing depressive symptoms among older adults. Promoting art and cultural engagement could be important to protect their mental health.

Viscoplastic Material Modeling for the Stretch Blow Molding Simulation

In this paper, the viscoplastic material model of PET (polyethylene terephthalate), which is intended to be used in the FEM (finite element method) simulation of stretch blow molding process, has been studied. Material tests of PET were performed with the constant strain rates varying from 0.01 to 1 (1/s), at temperatures ranging from 90 to 150 °C, based on the obtained data a two-stage model was proposed. The proposed model could precisely take into account the effects of strain hardening, strain rate sensitivity, variation of the hardening index, and temperature dependency. This model has been implemented into the nonlinear finite element code PBLOW3D, which is developed in the Riken, and its performance in the stretch blow molding simulation has been studied. It has been demonstrated that the proposed material model provides significant improvements, compared with two existing material models, in the simulation of the blow molding process of PET bottles.

Aging-in-place preferences and institutionalization among Japanese older adults: a 7-year longitudinal study

Background

In Asia, where autonomous decision-making is not well accepted, little is known about whether and how individuals’ preferences are considered when deciding where they receive care. This study examined whether individuals preferring to age in place if confined to bed were less likely to be institutionalized, using longitudinal data of Japanese older adults.

Methods

We analyzed nationally representative data of 1,290 community-dwelling older adults aged 70 and above. Baseline data were collected in 1999, shortly before the long-term care insurance system was introduced. The outcome was measured as self- or proxy-reported years of institutionalization over seven years. The explanatory variable was whether individuals preferred to age in place if they were confined to bed. Participants were asked about their desired place of care (facility, home, or other) if confined to bed. Covariates were sociodemographic and health-related factors. We used Cox proportional hazards models and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the association of aging-in-place preferences if confined to bed with institutionalization. We applied multiple imputation to deal with missing data.

Results

Seventy-eight respondents (6.0%) were institutionalized during the follow-up period. Compared to individuals preferring to reside in long-term care facilities if confined to bed (48.7%), those preferring to stay in their homes (39.6%) were less likely to be institutionalized, even after adjusting for relevant covariates (HR = 0.47, 95% CI 0.27–0.79 for model 1 including residential status; HR = 0.45, 95% CI 0.27–0.76 for model 2 including marital status and co-resident children).

Conclusions

Our findings suggest that individuals’ aging-in-place preferences tend to be considered under the long-term care insurance system. Individuals’ preferences should be shared with families and clinicians when deciding the place of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02766-5.

Older Adults' Resilience Against Impact of Lifestyle Changes During the COVID-19 Pandemic

Background

Older adults were expected to experience a decline in physical activities and an increase in social isolation during the COVID-19 pandemic.

Methods

We investigated the changes in living conditions of 508 older adults (79.70 years ± 0.88) before (from July to December 2019) and during (in August 2020) the pandemic. We compared the mean score for the same individual instrumental activities of daily living (IADL), frequency of going out, exercise, and social interaction at two-time points. We also examined the influence of living arrangement (living alone or not) on the frequency of exercise and social interaction.

Results

The frequency of going out decreased during the pandemic (in 2020); however, there was no significant change in IADL. The frequency of exercise and social interaction increased irrespective of the living arrangement. The frequency of exercise increased more in those living alone.

Conclusions

Although older adults refrained from going out, they compensated for the risks of inactivity in daily life by increasing or maintaining their frequency of exercise and social interactions. The view that "older adults have a poor ability to accommodate the lifestyle changes during the COVID-19 pandemic" may be a stereotypical assumption.

The use of SPECT/CT to assess resorptive activity in mandibular condyles

The aim of this study was to clarify the clinical significance of bone metabolism in the mandibular condyles in determining condylar resorptive changes. Twelve condyles of patients with idiopathic condylar resorption and degenerative joint disease were analysed using ^99mTc HMDP SPECT/CT at baseline and subsequent computed tomography during the follow-up period. Twenty-two healthy condyles were enrolled as controls. After generating three-dimensional SPECT/CT images, two independent observers scored the degree of condylar uptake and measured the morphological changes in the condylar height and condylar volume. In the group with positive condylar uptake, the follow-up computed tomography showed significant decreases in condylar height (-1.69 ± 0.93 mm) and condylar volume (-12.51 ± 10.30%) when compared to healthy controls (condylar height, 0.09 ± 0.54 mm; condylar volume, -0.29 ± 4.22%) (P < 0.001). Moreover, the degree of uptake correlated with the changes in condylar height (observer 1, P = 0.012; observer 2, P = 0.039) and condylar volume (observer 1, P = 0.005; observer 2, P = 0.037). These results suggest that condylar bone metabolism is closely related to the resorptive activity. Thus, SPECT/CT would be useful in the prognostic evaluation or determination of treatment strategies for idiopathic condylar resorption and degenerative joint disease.

Influence of Social Determinants on Self-Rated Health in Three Countries of East Asia

This study aims to compare five domains of social determinants and their associations with self-rated health (SRH) among older adults in China, Japan, and Korea, where they share some cultural values but the development and conditions of economic status, health care system, and education system vary. A total of 10,111 participants aged 65 years and older were included from three harmonized datasets at baseline CHARLS, KLoSA, and JSTAR. Guided by the Healthy People 2020 Framework, five domains of social determinants were included: education levels, economic stability (total income, working for pay), social and community context (social engagement, living with children), health care access (medical center utilization), and neighborhood (rural vs. urban). Regression models showed that working for pay, social engagement, and medical center utilization were significant predictors for SRH in three countries. However, unique predictors have also been observed in China and Korea, which will be discussed in the presentation.

Trajectories of Functional Health Following Stroke: The Role of Social Resources

Stroke is one of the major causes of disability in old age. Predictors for the functional prognosis have been studied, but the role of social resources in recovery has not studied as much. We examined whether social resources available before and after stroke onset improved functional prognoses. Data was derived from longitudinal data collected between 1987 and 2006 from Japanese adults aged 60 years and older. We identified 396 people who had experienced their self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 76.0, SD = 6.9; 74.2% women). Functional health was measured by self- or proxy-reported activities of daily living. Social resources were indexed as residential status, contact with non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, gender, and education. A multiphase growth model showed that functional health typically deteriorated surrounding stroke and gradually declined thereafter. There were also individual differences in the trajectories of functional health. Individuals who more frequently participated in social groups prior to stroke and those who came to participate more frequently thereafter exhibited less functional decline immediately following stroke. Our findings indicate that social participation plays a protective role against adverse prognoses following stroke regardless of when individuals start participating. Inclusive communities would enable older adults to remain independent. Our study was limited in that crucial information about stroke, such as objective measures of initial severity, was not available and that individuals with more severe stroke may have dropped out after the onset.