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

Community-level social capital and subsequent health and well-being among older adults in Japan: An outcome-wide longitudinal approach

There is inconsistent evidence on the association between community-level social capital and the health or well-being of older adults. This study examined the association between community-level social capital and multidimensional health and well-being outcomes using an outcome-wide approach. We used data from the Japan Gerontological Evaluation Study, a nationwide cohort study of Japanese older adults (analytic samples: 47,227 for outcomes obtained from the long-term care insurance registry and 34,183 for other outcomes). We assessed three aspects of school-district-level community social capital in 2016 (civic participation, social cohesion, and reciprocity) and 41 subsequent health and well-being outcomes through 2019. We performed either a modified multilevel Poisson regression or a multilevel logistic regression analysis. We adjusted for pre-baseline characteristics, prior outcome values, and individual-level social capital from the 2013 wave. Even after Bonferroni correction, we found that community-level social capital was associated with some subsequent social well-being and physical/cognitive health. For example, community-level reciprocity was associated with a higher prevalence of taking a social role (Prevalence ratio [PR] = 1.03, 95% confidence interval [CI] = 1.02, 1.04) and undergoing health screening (PR = 1.03, 95% CI: 1.01, 1.04). There was modest evidence that community-level civic participation was associated with a higher competency of intellectual activity (PR = 1.01, 95% CI: 1.01, 1.02) and community-level social cohesion was associated with a reduced onset of functional disability (PR = 0.94, 95% CI: 0.90, 0.98). Community-level social capital may promote social well-being and some physical/cognitive health outcomes.

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.

[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.

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.

Association between social isolation and depression onset among older adults: a cross-national longitudinal study in England and Japan

OBJECTIVE

Social isolation is a risk factor for depression in older age. However, little is known regarding whether its impact varies depending on country-specific cultural contexts regarding social relationships. The present study examined the association of social isolation with depression onset among older adults in England, which has taken advanced measures against social isolation, and Japan, a super-aged society with a rapidly increasing number of socially isolated people.

DESIGN

Prospective longitudinal study.

SETTING

We used data from two ongoing studies: the English Longitudinal Study of Ageing (ELSA) and the Japan Gerontological Evaluation Study (JAGES).

PARTICIPANTS

Older adults aged ≥65 years without depression at baseline were followed up regarding depression onset for 2 years (2010/2011-2012/2013) for the ELSA and 2.5 years (2010/2011-2013) for the JAGES.

PRIMARY OUTCOME MEASURE

Depression was assessed with eight items from the Centre for Epidemiologic Studies Depression Scale for the ELSA and Geriatric Depression Scale for the JAGES. Multivariable logistic regression analysis was performed to evaluate social isolation using multiple parameters (marital status; interaction with children, relatives and friends; and social participation).

RESULTS

The data of 3331 respondents from the ELSA and 33 127 from the JAGES were analysed. Multivariable logistic regression analysis demonstrated that social isolation was significantly associated with depression onset in both countries. In the ELSA, poor interaction with children was marginally associated with depression onset, while in the JAGES, poor interaction with children and no social participation significantly affected depression onset.

CONCLUSIONS

Despite variations in cultural background, social isolation was associated with depression onset in both England and Japan. Addressing social isolation to safeguard older adults' mental health must be globally prioritised.

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.

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.

Relationship between Individual Social Capital and Functional Ability among Older People in Anhui Province, China

This study aimed to explore the relationship between individual social capital and functional ability, with a focus on whether there is an interactive relationship that exists among social capital related to functional ability among older people in Anhui province, China. We conducted a cross-sectional study with a multi-stage stratified cluster random sampling method from July to September 2017. Data were collected through questionnaire including demographic characteristics, individual social capital status, and functional capability status. Binary logistic regression analysis model and classification and regression tree model (CART) were utilized. Overall, this study included 1810 elderly people, 43% of whom had functional disability. After the adjustment, subjects with lower social participation (AOR = 1.60; 95% CI: 1.26–2.03) and lower social connection (AOR = 1.74; 95% CI: 1.34–2.25) had an increased risk of functional disability. However, social support (AOR = 0.73; 95% CI: 0.57–0.94) was inversely related to functional ability. We also observed interactive relationship of social capital associated with functional ability, which indicated that special attention and efforts should be paid to older adults with less educational attainment, with multimorbidity, with advanced age, and with lower level of social participation, cohesion for the purpose of maintaining sound functional ability. Our findings may be of salient relevance for devising more targeted and effective interventions to prevent the onset of functional limitations among community-dwelling older adults.

Effect of walking on depression prevalence for diabetes using information communication technology: Prospective study

AIM

This study aimed to evaluate the prevention of diabetic depression and its impact on medical costs through the implementation of a step count monitoring system using information and communication technology.

METHODS

This study carried out a longitudinal analysis of a prospective cohort. A total of 296 participants were enrolled in the intervention group and 882 participants in the control group. The participants in the intervention group were provided with pedometers, which each participant was asked to scan using devices stationed throughout the city. Activity data were stored in real time by a cloud system. The experiment lasted 30 months.

RESULTS

None of the diabetes patients in the intervention group was diagnosed with depression during the study period, compared with 4.09% in the control group. Thus, the intervention suppressed the increase in medical costs for the people who did not develop depression in the diabetic group.

CONCLUSIONS

The prevalence rate of depression among the participants with diabetes was lowered significantly. The medical costs of the participants who did not have diabetes were also reduced by implementing the step count monitoring system with information and communication technology. This shows that the use of an information and communication technology pedometer system can have favorable effects in terms of preventing depression in diabetes patients and further benefits for non-diabetic people. Geriatr Gerontol Int 2019; 19: 1147-1152.