Community social capital and the onset of functional disability among older adults in Japan: a multilevel longitudinal study using Japan Gerontological Evaluation Study (JAGES) data

Associations of eHealth Literacy with Social Activity among Community-Dwelling Older Adults: A Cross-Sectional Study

Older adults who use digital technology are desired to adapt to digitalization and literacy. One required aspect is eHealth literacy, measured with the eHealth Literacy Scale (eHEALS). Many studies on eHealth literacy have used the eHEALS to examine the health behaviors of college students, relatively younger adults, and Internet users. However, the relevance of eHealth literacy to social activity has not yet been studied in older adults. The purposes of this study were to examine the relationship between eHealth literacy and health behaviors and social activities (community, cultural, and sports activities) and to investigate the factors associated with eHEALS scores among community-dwelling older adults. The mean eHEALS score was 12.4 points (SD 8.2), with the majority (73.3%) having the lowest score (the lowest score is 8 points). Males (17.6, SD 10.5) scored significantly higher than females (11.8, SD 7.7). The eHEALS score had a significant relationship with both cultural and community activity. Five factors significantly associated with having the lowest eHEALS score were cultural activity at least once a week, no cultural activity, no community activity, total IADL score, and intellectual activity. These results suggest that eHealth literacy is associated with community activity and cultural activity among older adults.

Sedentary behavior and the combination of physical activity associated with dementia, functional disability, and mortality: A cohort study of 90,471 older adults in Japan

OBJECTIVE

To examine the associations of sedentary behavior (SB) and the combination of moderate-to-vigorous intensity physical activity (MVPA) with dementia, functional disability, and mortality in older adults, and the heterogeneity in different subpopulations.

METHODS

Nation-wide cohort with 90,471 individuals aged ≥65 years in Japan. SB (<3, 3-<8, and ≥ 8 h per day [h/d]) and MVPA (0, 0 < MVPA<1, and ≥ 1 h/d) were measured in 2016. Long-term care registry-based incidence of outcomes was ascertained through 2021. Cox proportional hazard models were performed.

RESULTS

Compared with SB < 3 h/d group, SB ≥ 8 h/d was associated with higher risks of dementia, functional disability, and mortality with hazard ratios (95% confidence interval) of 1.36 (1.22-1.52), 1.32 (1.19-1.48), and 1.31 (1.18-1.45). The combination of MVPA and SB demonstrated a dose-respond trend of increasing risks of dementia, functional disability, and mortality with increased SB and decreased MVPA, where participants who spent no MVPA with SB ≥ 8 h/d had the highest risks. High MVPA attenuated but didn't eliminate the risks. Participants who spent MVPA≥1 h/d with SB ≥ 8 h/d had comparable risks to those who spent no MVPA with SB < 3 h/d. No heterogeneity was found by MVPA levels, sex, education, comorbidity, and depression conditions.

CONCLUSIONS

Prolonged daily SB was associated with higher risks of dementia, functional disability, and mortality in older adults, regardless of MVPA, sex, education, and chronic conditions. Individuals with high MVPA also face considerable risks when engaging in high SB. High MVPA with high SB revealed a comparable risk to no MVPA with low SB.

Estimating Health Expectancy in Japanese Communities Using Mortality Rate and Disability Prevalence

Introduction

Although mortality and disability are known to be associated with health expectancy (LE), few studies have assessed the extent to which a reduction in their prevalence can extend a person's LE. Moreover, differences in this relationship based on gender have not been established. Thus, in this study, we constructed a regression model using the rate of mortality and prevalence of disability to predict LE in older adults (≥65 years) and assess the relationships between LE, mortality rate, and disability prevalence based on gender.

Methods

Data were collected from Japan's population registry and long-term insurance records (N = 344). Multiple linear regression was used to analyze the relationship between LE, mortality rate, and disability prevalence, stratified by gender.

Results

Age-adjusted mortality rate and disability prevalence significantly predicted LE and were significantly correlated with the measured LE index for both genders. For every 1% annual decrease in age-adjusted mortality, LE increased by 1.54 years for men and 2.15 years for women. Similarly, a 1% annual decrease in age-adjusted disability prevalence increased LE by 0.22 years for men and 0.32 years for women. The regression model coefficients indicated that the strength of the association between LE, mortality rate, and disability prevalence differed between genders. Our model accurately predicted LE (men: adjusted R2 = 0.968, women: adjusted R2 = 0.994).

Conclusions

Health promotion policies that are geared toward increasing health expectancy can be evaluated using mortality rate and disability prevalence as prognostic indicators. The strength of the association between LE, mortality, and disability differed between genders, suggesting the need for gender-specific policy planning to increase LE for both genders.

Machine Learning-Based Prediction of Functional Disability: a Cohort Study of Japanese Older Adults in 2013-2019

BACKGROUND

It is important to identify older adults at high risk of functional disability and to take preventive measures for them at an early stage. To our knowledge, there are no studies that predict functional disability among community-dwelling older adults using machine learning algorithms.

OBJECTIVE

To construct a model that can predict functional disability over 5 years using basic machine learning algorithms.

DESIGN

A cohort study with a mean follow-up of 5.4 years.

PARTICIPANTS

We used data from the Japan Gerontological Evaluation Study, which involved 73,262 people aged  ≥ 65 years who were not certified as requiring long-term care. The baseline survey was conducted in 2013 in 19 municipalities.

MAIN MEASURES

We defined the onset of functional disability as the new certification of needing long-term care that was ascertained by linking participants to public registries of long-term care insurance. All 183 candidate predictors were measured by self-report questionnaires.

KEY RESULTS

During the study period, 16,361 (22.3%) participants experienced the onset of functional disability. Among machine learning-based models, ridge regression (C statistic = 0.818) and gradient boosting (0.817) effectively predicted functional disability. In both models, we identified age, self-rated health, variables related to falls and posture stabilization, and diagnoses of Parkinson's disease and dementia as important features. Additionally, the ridge regression model identified the household characteristics such as the number of members, income, and receiving public assistance as important predictors, while the gradient boosting model selected moderate physical activity and driving. Based on the ridge regression model, we developed a simplified risk score for functional disability, and it also indicated good performance at the cut-off of 6/7 points.

CONCLUSIONS

Machine learning-based models showed effective performance prediction over 5 years. Our findings suggest that measuring and adding the variables identified as important features can improve the prediction of functional disability.

Associations of Cooking Skill with Social Relationships and Social Capital among Older Men and Women in Japan: Results from the JAGES

The health benefits of social relationships and social capital are well known. However, little research has examined the determinants of social relationships and social capital. We examined whether cooking skill was associated with social relationships and social capital in older Japanese people. We used 2016 Japan Gerontological Evaluation Study data on a population-based sample of men and women aged ≥ 65 years (n = 21,061). Cooking skill was assessed using a scale with good validity. Social relationships were evaluated by assessing neighborhood ties, frequency and number of meetings with friends, and frequent meals with friends. Individual-level social capital was evaluated by assessing civic participation, social cohesion, and reciprocity. Among women, high-level cooking skill was positively associated with all components of social relationships and social capital. Women with high-level cooking skill were 2.27 times (95% CI: 1.77-2.91) more likely to have high levels of neighborhood ties and 1.65 (95% CI: 1.20-2.27) times more likely to eat with friends, compared with those with middle/low-level cooking skill. Cooking skills explained 26.2% of the gender difference in social relationships. Improving cooking skills may be key to boosting social relationships and social capital, which would prevent social isolation.

Preventive role of community-level social capital in the need for long-term care and impairment in instrumental activities of daily living: a multilevel analysis

BACKGROUND

Individual-level social capital is an important determinant of older adults' long-term care needs; however, there is scant evidence regarding community-level social capital. Therefore, we investigated the association between community-level social capital and the prevalence of the need for long-term care among older adults.

METHODS

Between January and February 2018, a cross-sectional survey was conducted among all older adults (n = 13,558) aged 65 to 74 years in a rural municipality in Japan (total population, n = 72,833). A self-reported questionnaire was used to identify community-level social capital, comprising civic participation, social cohesion, and reciprocity. A multilevel logistic regression analysis was performed to estimate the odds ratios of the need for long-term care and a decline in social activity competence as assessed by instrumental activities of daily living. For the analysis, the community levels were divided into 76 voting districts and adjusted for daily life, lifestyle, socioeconomic status, health conditions, and the three social capital subscale scores at the individual level.

RESULTS

After adjusting for the covariates, we observed a tendency that a higher community level of reciprocity was associated with a lower prevalence of long-term care needs (OR: 0.86, 95% confidence interval: 0.75-1.00), whereas a high community level of social cohesion was associated with a significantly reduced decline in instrumental activities of daily living (OR per standard deviation increase: 0.87, 95% confidence interval: 0.79-0.96). No significant association was found with civic participation. Similarly, individual-level social capital was associated with the need for long-term care and decline in instrumental activities of daily living.

CONCLUSIONS

Our findings suggest that good community-level reciprocity or social cohesion as well as good individual social capital status may help prevent the need for long-term care among older adults.

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.

[Longitudinal association between social capital and functional disability in a cohort of community dwelling older adults]

This study aimed to investigate the association between social capital and functional disability, based on a longitudinal perspective, using data from the cohort of older adults from Bambuí, Minas Gerais State, Brazil. The baseline of this study was composed of all surviving and disability-free - up until the seventh year of follow-up (2004) - older adults who were followed up until 2011. The outcome variable was functional disability for basic activities of daily living (ADL) and instrumental activities of daily living (IADL), separately analyzed. Social capital was the exposure of interest, measured through its cognitive (cohesion and social support) and structural (social participation and satisfaction with the neighborhood) components. Sociodemographic variables, health conditions, and lifestyle habits were used for adjustment purposes, and the occurrence of death was considered a competitive event. The hypothesis of association between social capital and functional disability was tested using the competing risk model, which provides hazard ratios (HR) and a 95% confidence interval (95%CI). After multivariate analysis, social capital - in its structural component - was associated with functional disability. Older adults who were dissatisfied with the neighborhood had a higher risk of developing functional disability for IADL (HR = 2.36; 95%CI: 1.31-4.24), in relation to their counterparts. This study results suggest that functional disability is associated with aspects other than health, evidencing the need for the development of policies and interventions that support aspects related to the physical and social environment in which older adults live.

Does Residing in a Neighborhood of High Social Participation Postpone Deterioration in Health among Middle-Aged Adults? A Multilevel Survival Analysis in Japan

Social participation (SP) is known to have a favorable impact on an individual's health. This study examined whether residing in a neighborhood with a high SP level would be predictive of delayed deterioration in health outcomes, even after controlling for individual SP. With the 14-wave longitudinal data of 32,388 individuals (15,749 men and 16,639 women) aged 50-59 years residing in 2,477 neighborhoods in 2005, we used multilevel Cox proportional hazards models to examine the impact of neighborhood SP on the onset of problems in activities of daily living (ADL), poor self-rated health, and psychological distress. Residing in a neighborhood with high SP levels modestly postponed the onset of health problems in individuals. The hazard ratio (HR) of ADL problems in response to residing in a neighborhood with above-average SP levels was 0.92 (95% confidence interval [CI]: 0.85-0.99) and 0.93 (95% CI: 0.87-1.00) for men and women, respectively, even after controlling for an individual's SP and other attributes. The results for other health outcomes showed a similar pattern. These findings suggest that high neighborhood SP has a favorable impact on health among middle-aged adults, independent of individual SP. Policy measures to enhance and promote neighborhood SP are thus needed in terms of public health.

Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis

Background

Methods

Findings

Interpretation

Funding

Risk Factors of Long-Term Care Insurance Certification in Japan: A Scoping Review

This study aimed to review evidence on future long-term care associated with pre-existing factors among community-dwelling Japanese older adults. We systematically searched cohort and nested case–control studies published between 2000 and 2019 that assessed long-term care certification using the PubMed, CINAHL, and EMBASE databases. The relationship between long-term care insurance information and risk factors was investigated. The protocol was registered with the Open Science Framework. We extracted 91 studies for synthesis, including 84 prospective cohort studies, 1 retrospective cohort study, and 6 nested case–control studies. Certification for long-term care was classified into two endpoints: onset of functional disability and dementia. There were 72 studies that used long-term care certification as a proxy for functional disability, and 22 used long-term care information to indicate the onset of dementia. Common risk factors related to functional disability were physical function, frailty, and oral condition. Motor function and nutritional status were common risk factors for dementia. We found consistent associations between premorbid risk factors and functional disability and dementia. The accumulation of evidence on the incidence of long-term care and associated factors can aid the development of preventive measures. Future studies should aim to integrate this evidence.

Association of Structural Social Capital and Self-Reported Well-Being among Japanese Community-Dwelling Adults: A Longitudinal Study

Previous studies have shown both positive and non-positive associations between social capital and health. However, longitudinal evidence examining its comprehensive effects on well-being is still limited. This study examined whether structural social capital in the local community was related to the later well-being of Japanese people aged 40 or above. A 4-year longitudinal study was conducted in a rural Japanese town. “Well-being” was measured using three indicators (happiness, self-rated health, and depressive symptoms), and those who were high in well-being in the baseline 2015 survey and responded to the follow-up 2019 survey were analyzed (n = 1032 for happiness, 938 for self-rated health, and 471 for depressive symptoms). Multilevel Poisson regression analysis adjusted for covariates showed that having contact with fewer neighbors was associated with a decline in happiness at both the community level (adjusted relative risk = 1.64, 95% confidence interval = 1.20–1.63) and the individual level (adjusted relative risk = 1.51, 95% confidence interval = 1.05–2.17), but participation in local community activities was not. The results suggest that dense personal networks might be more important in areas with thriving local community activities, not only for individuals but also for all community members.

Association between community-level social capital and frailty onset among older adults: a multilevel longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

Background

Little is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data.

Methods

This prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan.

Results

In total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants’ mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status.

Conclusions

Living in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.

Social capital and pneumococcal vaccination (PPSV23) in community-dwelling older Japanese: a JAGES multilevel cross-sectional study

OBJECTIVE

Inequalities exist between the 23-valent pneumococcal polysaccharide vaccination (PPSV23) rate in each municipality among Japanese older adults. Exploring individual-level and community-level intervenable factors is necessary to improve the vaccination rates. We examined the associations between community-level and individual-level social capital and the PPSV23 vaccination among older Japanese adults using multilevel Poisson regression analyses.

DESIGN

Cross-sectional study.

SETTING

We used data from the Japan Gerontological Evaluation Study, conducted between 3 October 2016 and 10 January 2017 in 631 districts, 39 municipalities and 18 prefectures.

PARTICIPANTS

The target population comprised persons aged 65 years or older who are physically and cognitively independent (that is, not certified as needing long-term care). Further, 180 021 older adults from 39 Japanese municipalities were enrolled.

PRIMARY OUTCOME MEASURE

The primary outcome was the PPSV23 vaccination among the Japanese older adults aged 65 years or older who did not have physical or cognitive disabilities.

RESULTS

After adjusting for municipality-, community-, individual-levels effects with multiple imputation, 137 075 individuals who participated in one/more of the civic participation (participation of social groups), social cohesion (social tie), or reciprocity (mutual exchange of social support) were significantly associated with more vaccinations than those without the three social capitals among the 137 075 older adults (13.0% (95% CI 11.0% to 14.9%), 5.0% (95% CI 2.4% to 7.6%) or 33.9% (95% CI23.6% to 44.2%) increase, respectively, p>0.001 for all). The rich (≥+1 SD) community-level civic participation was significantly associated with 3.4% increase [95% CI 0.02% to 6.78%, p<0.05] of the PPSV23 vaccination among the older adults compared to those with the poor or standard one.

CONCLUSIONS

Older adults with one/more of the three social capitals at the both levels received more PPSV23 vaccinations than those without those social capitals. Therefore, fostering of those social capitals may improve the inequality of the PPSV23 vaccination rate among older adults in each municipality.

The values and meanings of social activities for older urban men after retirement

Previous studies have indicated that older men often experience disconnection from the community after retirement. Social activities have been shown to be effective in preventing social isolation among older urban men. Nevertheless, it has been reported that they often do not participate in community social activities and tend to be reluctant to do so. We explored the values and meanings of social activities for retired older men living in an urban area of Japan to understand support using social activities that are more suitable for them. Semi-structured interviews were conducted with 15 older men (aged 68–80 years; M = 74.6 ± 3.79 years) about their interactions with family and non-family members, and their participation in various community social activities. The grounded theory approach was used for the analysis. As a result, the following five categories were derived as the values that participants place on the social activities that they engage in: “health as a resource and reward for social activities,” “feeling I am still useful,” “feeling that something is my responsibility,” “feeling of time well spent,” and “finding interest through interactions.” In addition, the following three categories were extracted as meanings of social activities: “fulfilling social life,” “maintaining stable family relationships,” and “maintaining safety and peace in the community.” When considering the social activities that older urban retired men are interested in and likely to participate in, these five values can be considered indicators. In contrast, to maintain stable family relationships and safety and peace in the community, participants sometimes used strategies to stop or abandon social activities. Therefore, in situations where a peaceful life within a family or neighborhood is threatened, it may be useful to help set aside sufficient time and allow for psychological leeway in advance to incorporate social activities into their lives.

Residents living in communities with higher civic participation report higher self-rated health

It has been shown that community-level social capital may affect residents' health. The present mixed ecological study assesses the evidence for an association between the community-level social capital and the individual level of self-rated health. The Hakui City Health Interview Survey targeted 15,242 people aged 40 years and older from 11 communities. Among them, 6578 residents responded to the questionnaire (response rate, 43.2%). We examined whether the community-level social capital (general trust, norm, and civic participation) was associated with the individual level of self-rated health. Overall, 1919 (29.1%) answers of self-rated poor health were identified. Community-level civic participation was negatively associated with poor self-rated health after adjusting for individual demographic factors, individual social capitals, and community-level economic status, whereas community-level general trust, and norm were not significant. The findings suggest the importance of fostering communities with high civic participation to reduce the poor health status of residents.