Weight Loss Mediated the Relationship between Tooth Loss and Mortality Risk

Tooth loss is a risk factor for increased mortality; however, the underlying mechanism remains unclear. This study aimed to evaluate the mediating effect of weight change on the relationship between tooth loss and mortality risk. This was a 10-y follow-up prospective cohort study using the data from the Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 y at baseline and were followed up from 2010 to 2020. The incidence of death in 2013 and 2020, incidence of >5% weight loss/gain in 2010 and 2013, and the number of remaining teeth in 2010 were used as the outcome, mediator, and explanatory variables, respectively. We conducted causal mediation analysis by fitting the Cox proportional hazard model, including possible confounders. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the total effect (TE), natural indirect effect (NIE), and proportion mediated (PM) were estimated. Among the 34,510 participants, the mean age was 72.6 (SD = 5.4) y, and 47.6% were men. From 2013 to 2020, 14.0% of the participants (n = 4,825) died, 60.5% (n = 20,871) had 0 to 19 remaining teeth, and 17.2% (n = 5,927) and 8.4% (n = 2,907) experienced >5% weight loss and gain, respectively. The mortality rate was 0.016 per person-year among those with ≥20 remaining teeth and 0.027 per person-year among those with 0 to 19 remaining teeth. Weight loss of >5% significantly mediated the association between tooth loss and higher mortality risk (TE: HR, 1.28 [95% CI, 1.16 to 1.40]; NIE: HR, 1.03 [95% CI, 1.02 to 1.04]; PM, 13.1%); however, we observed a slight mediating effect for >5% weight gain (NIE: HR, 1.003 [95%CI, 1.0001 to 1.01]; PM, 1.3%). The present study suggests that a clinically meaningful level of weight loss mediated the association between tooth loss and increased risk of mortality among independent older adults.

Post-Disaster Mental Health and Dietary Patterns among Older Survivors of an Earthquake and Tsunami

OBJECTIVES

Research suggests that cardiometabolic disease risks are elevated among survivors of natural disasters, possibly mediated by changes in diet. Using the Brief Dietary History Questionnaire, we examined (1) dietary patterns among older survivors of the 2011 Great East Japan Earthquake and Tsunami, and (2) the contribution of posttraumatic stress symptoms (PTSS)/depressive symptoms, as well as relocation to temporary housing on dietary patterns and (3) gender differences in the associations.

DESIGN, SETTING AND PARTICIPANTS

Data came from a prospective cohort study of 1,375 survivors aged 65-89 years (44.6% male).

MEASUREMENTS

PTSS/depression onset was evaluated in 2013, 2.5 years after the disaster. Dietary data was collected with a self-administered brief-type diet history questionnaire in 2020. A principal component analysis identified three posterior dietary patterns.

RESULTS

Diet 1 consisted of high intake of vegetables, soy products, and fruits; Diet 2 consisted of carbohydrate-rich foods and snacks/sweets; Diet 3 consisted of high intake of alcoholic beverages, meat, and seafood. Least-squares linear regression revealed that individuals with PTSS/depression were less likely to exhibit Diet 1, while individuals with PTSS were more likely to exhibit Diet 2 and 3. Especially, males who had depression showed an unhealthy dietary pattern. Those who have lived in a trailer-style temporary housing reported less consumption of Diet 3.

CONCLUSION

Survivors of disaster with symptoms of mental illness tended to exhibit less healthy dietary patterns after 9 years. Diet varied by type of post-disaster mental illness, gender, and current social circumstances. We lacked pre-disaster BDHQ data, which is a limitation.

Geriatric symptoms associated with healthy life expectancy in older people in Japan

BACKGROUND

We investigated the relationship between characteristic geriatric symptoms and healthy life expectancy in older adults in Japan. Additionally, we determined relationship predictors that would help formulate effective approaches toward promoting healthy life expectancy.

METHODS

The Kihon Checklist was used to identify older people at high risk of requiring nursing care in the near future. We evaluated the association of geriatric symptoms with healthy life expectancy while considering risk factors (frailty, poor motor function, poor nutrition, poor oral function, confinement, poor cognitive function, and depression). Data from the 2013 and 2019 Japan Gerontological Evaluation Studies were used. Healthy life expectancy was assessed using the multistate life table method.

RESULTS

Overall, 8,956 individuals were included. For both men and women, healthy life expectancy was shorter in the symptomatic group than in the asymptomatic group for several domains of the Kihon Checklist. For men, the difference between individuals with risk factors and those with no risk factors was the maximum for confinement (3.83 years) and the minimum for cognitive function (1.51 years). For women, the difference between individuals with risk factors and those with no risk factors was the maximum for frailty (4.21 years) and the minimum for cognitive function (1.67 years). Healthy life expectancy tended to be shorter when the number of risk factors was higher. Specifically, the difference between individuals with ≥3 risk factors and those with no risk factors was 4.46 years for men and 5.68 years for women.

CONCLUSIONS

Healthy life expectancy was negatively associated with characteristic geriatric symptoms, with strong associations with frailty, physical functional decline, and depression. Therefore, comprehensive assessment and prevention of geriatric symptoms may increase healthy life expectancy.

[Changes in the neighborhood food environment and walking time among older adults: A longitudinal Japan Gerontological Evaluation Study (JAGES) between 2016 and 2019]

Objective　Maintaining or increasing walking provides several health benefits to older adults. However, the mid-term evaluation of Health Japan 21 [second term] showed that older adults' daily steps did not meet the goal. Therefore, this study emphasized primordial prevention, which is different from previous preventive approaches and focuses on the relationship between the built environment and physical activities, including daily steps. This study investigated the relationship between changes in the number of food stores and walking time.Methods　This longitudinal study utilized the self-administered mail survey data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Older adults aged ≥65 years and residing in 27 independent municipalities were recruited. The dependent variable was a change in the walking time at two-time points (increase or not). Our explanatory variable was the change in the number of food stores at two-time points, reported on a 5-point scale, including no store (reference), increased stores, store available, decreased stores, and I don't know. Equivalently, it was defined as the self-reported change in the number of food stores (stores that sell meats, fish, fruits, and vegetables) within the walking distance of participants' homes (within ～1 km) from 2016 to 2019. The covariates included demographic factors, health behavior factors, environmental factors, and health factors in 2016. We used Poisson regression analysis (5% significance level) to calculate the cumulative incidence rate ratio (CIRR) and 95% confidence interval (CI) for an increase in walking time compared to no increase in walking time. The multivariate normal imputation method supplemented missing data of the dependent variable, explanatory variable, and covariates. Additionally, respondents' answer of "other" for the covariates was supplemented.Results　Three years later, 13,400 (20.4%) respondents had increased their walking time. Older adults who reported increased number of stores (5,311, 8.1%) had more walking time than those who reported no stores (6,577, 10.0%) (CIRR=1.12; 95% CI: 1.03-1.21).Conclusion　Participants who reported an increase in the number of fresh food stores within the walking distance had 12% more walking time three years later. A built environment might be used to measure primordial prevention that increases the amount of walking in daily life. Our results may provide evidence for policymakers and stakeholders to consider healthy urban planning.

[Correlates of walking time by exercise stage of change in older adults in Japan: The 2019 JAGES cross-sectional study]

Objectives　Some older adults less interested in exercise may still meet the walking time of 30 minutes or more per day that is required to maintain and improve their health. This study aimed to clarify the characteristics of those who walk for 30 minutes or more per day stratified by the exercise stage of change.Methods　This cross-sectional study used a self-administered mail survey conducted by the Japan Gerontological Evaluation Study (JAGES) in 2019. There were 45,939 participants, aged 65 years or above, who were not certified as requiring long-term care and who resided in 62 municipalities in 24 prefectures. The measures included daily walking time, stage of change for exercise (20 minutes or more once a week), and factors related to physical activities (eight demographic and biological; three psychological, cognitive, and emotional; eight behavioral; 40 social and cultural; and three environmental factors). The analysis was stratified into three groups according to the transformation stages: 1) pre-contemplation, 2) contemplation/preparation, and 3) action/maintenance. Poisson regression analysis was conducted with the dependent variable as walking time, the independent variables as physical activity factors, and the covariates as all eight demographic and biological factors.Results　Of the 24,146 survey respondents (52.6% response rate), 18,464 were included in the analysis. Surveys with missing items that were important for the analysis and patients who needed care and assistance were excluded. The factors that were significantly associated with walking 30 minutes or more per day only in the pre-contemplation stage, or only in the precontemplation and the contemplation/preparation stages, were three demographic and biological (married; age 80 years or above and non-independence of instrumental activities of daily living were negatively associated), two behavioral (going out at least once a week and watching sports on TV or the Internet), and six social and cultural factors (provision of instrumental support, frequency of meeting with friends more than once a week, participation in the neighborhood association, high reciprocity, reading habits; playing Go was negatively associated).Conclusions　Among the demographic and biological factors, and the behavioral, social, and cultural factors, 11 items were found to be associated with walking 30 minutes or more per day only in the pre-contemplation stage, or only in the precontemplation and contemplation/preparation stages. To promote walking even in the lower stages of change, it may be useful to promote exchanges with others, rather than focusing predominantly on physical activities.

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.

Pneumonia and subsequent risk of dementia: Evidence from the Japan Gerontological evaluation study

BACKGROUND

Recently, several studies reported that pneumonia might increase the risk of cognitive decline and dementia due to increased frailty.

OBJECTIVES

This study aims to examine the association between a history of pneumonia and subsequent dementia risk.

METHODS

Participants were 9952 aged 65 years or older Japanese men and women from the Japan Gerontological Evaluation Study prospective cohort study, followed up from 2013 to 2019. Dementia was identified by public long-term care insurance registration. A history of pneumonia contracted 1 year before the baseline questionnaire in 2013. A cox regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia risk, adjusted for potential confounding variables. We conducted competing risk analyses using a cause-specific hazard model.

RESULTS

During the follow-up period of 6 years, 939 persons developed dementia. There was no association between having a prior history of pneumonia with dementia risk (HR 1.20, 95% CI:0.81-1.78). However, we observed an increased risk of dementia in persons with pre-frailty and frailty; the multivariable HR (95% CI) was 1.75 (1.48-2.07) and 2.42 (2.00-2.93) for pre-frailty and frailty, respectively. When pneumonia and frailty were combined, the risk of dementia was the highest for the persons with a history of pneumonia and frailty; the multivariable HR (95% CI) was 2.30 (1.47-3.62). The multivariable HR (95% CI) for those without pneumonia with frailty was 1.95 (1.66-2.28). Meanwhile, the multivariable HR (95% CI) for those with pneumonia without frailty was 1.64 (0.68-3.99).

CONCLUSION

Our findings imply that a prior history of pre-frailty and frailty with or without pneumonia, but not a history of pneumonia per se, was associated with an increased risk of dementia among population-based-cohort of older Japanese people.

Built environments and frailty in older adults: A three-year longitudinal JAGES study

BACKGROUND

This study investigated the relationship between built environments and the onset of frailty after 3 years.

METHODS

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals.

RESULTS

After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99).

CONCLUSIONS

At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.

Association of functional competencies with vaccination among older adults: a JAGES cross-sectional study

It is unknown whether higher functions in sublevels of competence other than instrumental activities of daily living (IADL) are associated with vaccinations. This study examined whether higher functions, including intellectual activity (IA) and social role (SR), were associated with vaccinations among 26,177 older adults. Older adults with incapable activities in IA and SR had increased risks for non-receipt of influenza vaccinations (IA: for one incapable task/activity: incident rate ratio (IRR) = 1.05, 95% confidence interval (CI) = 1.02-1.09; SR: for two incapable tasks: IRR = 1.12, 95% CI = 1.08-1.16). Those with incapable activities in IADL and IA had increased risks for non-receipt of pneumococcal vaccination (IADL: for two incapable tasks: IRR = 1.13, 95% CI = 1.05-1.23; IA: for two incapable tasks: IRR = 1.10, 95% CI = 1.08-1.12). Those with incapable activities in IADL, IA, and SR had increased risks for non-receipt of both of the two vaccinations (IADL: for two incapable tasks: IRR = 1.17, 95% CI = 1.03-1.33; IA: for two incapable tasks: IRR = 1.18, 95% CI = 1.11-1.25; SR: for two incapable tasks: IRR = 1.13, 95% CI = 1.07-1.20). Having a family physician mitigated associations for non-receipt, regardless of competency. Our results suggest-maintaining the higher functions are important for older adults to undergo recommended vaccinations as scheduled; also, having a family physician to promote vaccinations is beneficial even for older adults with limited functions.

Types of Sports and Exercise Group Participation and Sociopsychological Health in Older Adults: A 3-Yr Longitudinal Study

PURPOSE

This study aimed to identify the association between a specific sports type and exercise group participation and longitudinal changes in sociopsychological health among community-dwelling older adults.

METHODS

Three years of data from the Japan Gerontological Evaluation Study were used, comprising a total of 33,746 men and 36,799 women age ≥65 yr. To determine the relationship between 20 types of sports and exercise group participation in 2016 (baseline) and changes in depressive symptoms (Geriatric Depression Scale (GDS-15)), self-rated health (4-point scale), subjective well-being (11-point scale), and frequency of laughter (days per month) from 2016 to 2019, we performed linear regression analyses with conducting a multivariate adjustment for potential confounders using an inverse probability weighting method.

RESULTS

The mean changes over 3 yr were +0.32 and +0.28 in GDS-15, -0.06 and -0.05 in self-rated health, -0.08 and -0.06 in subjective well-being, and -1.21 and -1.19 in frequency of laughter, in men and women, respectively. Men playing golf in a group were more likely to suppress an increase in the GDS-15 ( B = -0.11, 95% confidence interval, -0.18 to -0.05) and decreases in self-rated health (0.04, 0.02 to 0.06), subjective well-being (0.07, 0.02 to 0.12), and frequency of laughter (0.45, 0.11 to 0.80). Women participating in walking, weight exercises, and hiking groups were more likely to prevent an increase in the GDS-15 (-0.12, -0.19 to -0.04; -0.09, -0.18 to -0.01; and -0.16, -0.30 to -0.03, respectively) and decreases in self-rated health (0.03, 0.01 to 0.05; 0.03, 0.01 to 0.06; and 0.08, 0.04 to 0.12, respectively).

CONCLUSIONS

Golf in older men and walking, weight exercises, and hiking in older women could be recommended as an effective program for promoting sociopsychological health among older adults in Japan.

Family social support and stability of preferences regarding place of death among older people: a 3-year longitudinal study from the Japan Gerontological Evaluation Study

BACKGROUND

it remains unclear how family relationships could affect stability of end-of-life care preferences.

OBJECTIVE

to describe change patterns of preferred place of death (POD) among older people and to examine associations between family social support and stability of preferences regarding POD.

METHODS

this longitudinal study of 1,200 noninstitutionalized independent Japanese older people aged over 65 years used panel data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Preference stability was defined as the congruence of preferred POD based on questionnaires between baseline and follow-up. We performed multiple logistic regression analysis and gender-stratified analysis to examine associations between social support (spouse, children living together and children living apart) and preference stability.

RESULTS

only 40.9% of participants had stable preferences. For a spouse, both receiving and providing social support was associated with less stable preferences (OR: 0.63, 95% CI: 0.43-0.93; OR: 0.55, 95% CI: 0.38-0.80, respectively), and providing social support to children living apart was associated with more stable preferences (OR: 1.35, 95% CI: 1.03-1.76). In gender-stratified analysis, significant associations between preference stability and providing social support to a spouse among women (OR: 0.53, 95% CI: 0.34-0.82) and providing social support to children living apart among men (OR: 1.72, 95% CI: 1.16-2.55) were observed.

CONCLUSIONS

family social support was associated with the stability of preferences, and the associations differed by support resources and gender. Incorporating family members in the process of end-of-life care discussion may be necessary for establishing stable preferences.

Long-Term Trend in the Association Between Disaster Damage and Happiness Before and After the Great East Japan Earthquake

Objectives: Disasters change survivors’ living circumstances, which can affect their happiness. We examined the trends in the association between disaster damage and happiness before and after a disaster.

Methods: We analyzed 4,044 participants aged ≥65 years who had experienced the Great East Japan Earthquake in 2011. The baseline survey was conducted 7 months before the disaster. Follow-up surveys have been conducted every 3 years. Using a mixed model for repeated measures, we compared the prevalence ratios (PRs) for unhappiness according to the survivors’ level of housing damage, which is a proxy for disaster damage.

Results: The unhappiness in participants who suffered severe damage appeared to be higher than in those with no damage in 2010 (multivariate-adjusted PR: 1.18, 95% confidence interval: 0.93–1.48). A higher PR was observed after the earthquake in 2013 (1.34, 0.79–2.28), while there was no difference in 2016 (1.02, 0.53–1.97) and 2019 (1.03, 0.50–2.12).

Conclusion: The prevalence of unhappiness in survivors with severe housing damage was higher before the disaster. However, the unhappiness gap between people with and without housing damage converged during the follow-up.

The association between street connectivity and depression among older Japanese adults: the JAGES longitudinal study

Mental health is important in older age; neighborhood environment is considered a protective factor of depression. Research has established that a critical indicator of neighborhood environment, street connectivity, is related to older people's health. However, little is known about the relationship between street connectivity and depression. We examined the relationship between street connectivity and depression among older people. Using Japan Gerontological Evaluation Study 2013-2016, the target population comprised 24,141 independent older people without depression (Geriatric Depression Scale scores below 5) in 2013. The outcome variable was depression in 2016; the explanatory variable was street connectivity calculated by intersection density and space syntax within 800 m around the subject's neighborhood in 2013. We used logistic regression analysis to calculate the odds ratio and 95% confidence interval for the new occurrence of depression among participants in 2016. This analysis demonstrated incidence of new depression after 3 years that is 17% and 14% lower among participations living in high-intersection density and high-street-connectivity areas, respectively, than those living in low-intersection density and low-street-connectivity areas. The association held after adjusting for physical activities and social interaction. Given the established connection between street connectivity and mental health, the findings can contribute to healthy urban planning.

Prevalence and municipal variation in chronic musculoskeletal pain among independent older people: data from the Japan Gerontological Evaluation Study (JAGES)

BACKGROUND

Urbanization and population aging may affect prevalence of chronic pain from various causes. This cross-sectional study aimed to investigate the prevalence of chronic musculoskeletal pain, including some subtypes, in independent Japanese older people, and whether population density and population aging rate explained prevalence and differences in pain levels between municipalities.

METHODS

We analyzed data from 12,883 independent older people living in 58 municipalities who completed mailed questionnaires and did not need support for daily living. We identified three types of pain: "chronic musculoskeletal pain" lasting ≥ 3 months (overall and in each part of the body), "chronic widespread-type pain" in the spinal and peripheral area, and "chronic multisite pain" in at least three sites. The latter two were measured using new definitions. These types of pain are correlated with depressive symptoms and we therefore examined the construct validity of the definitions by comparing the Geriatric Depression Scale score. We also used analysis of covariance to compare the prevalence of these three types of pain between municipalities. Odds ratios, median odds ratios, and the municipal variance in prevalence of chronic musculoskeletal pain were estimated by Bayesian multilevel logistic regression analysis using the Markov Chain Monte Carlo method.

RESULTS

The construct validity of the definitions of chronic widespread-type pain and chronic multisite pain was confirmed. The prevalence of the three types of pain (chronic musculoskeletal, widespread, and multisite pain) was 39.0%, 13.9%, and 10.3%, respectively. Chronic musculoskeletal pain showed a higher prevalence among older people and women. Individuals in underpopulated, suburban, or metropolitan areas tended to have more pain than those in urban areas, but this was not statistically significant (odds ratio [95% credible interval] 1.15 [0.86-1.51], 1.17 [0.93-1.43], 1.17 [0.94-1.46]). Population density and population aging rate did not explain the differences between municipalities.

CONCLUSIONS

The prevalence of chronic musculoskeletal pain was consistent with previous global reports. Areas with overpopulation and depopulation tended to have higher pain prevalence, but population density and population aging rate did not explain municipal variance. Further research is needed to identify other factors that contribute to regional variance.

Optimism and Longevity Among Japanese Older Adults

BACKGROUND

Optimism has been linked to better physical health across various outcomes, including greater longevity. However, most evidence is from Western populations, leaving it unclear whether these relationships may generalize to other cultural backgrounds. Using secondary data analysis, we evaluated the associations of optimism among older Japanese adults.

METHODS

Data were from a nationwide cohort study of Japanese older adults aged ≥65 years (Japan Gerontological Evaluation Study; n = 10,472). In 2010, optimism and relevant covariates (i.e., sociodemographic factors, physical health conditions, depressive symptoms, and health behaviors) were self-reported. Optimism was measured using the Japanese version of the Life Orientation Test-Revised (LOT-R). Lifespan was determined using mortality information from the public long-term care insurance database through 2017 (7-year follow-up). Accelerated failure time models examined optimism (quintiles or standardized continuous scores) in relation to percent differences in lifespan. Potential effect modification by gender, income, and education was also investigated.

RESULTS

Overall, 733 individuals (7%) died during the follow-up period. Neither continuous nor categorical levels of optimism were associated with lifespan after progressive adjustment for covariates (e.g., in fully-adjusted models: percent differences in lifespan per 1-SD increase in continuous optimism scores= -1.2%, 95%CI: -3.4, 1.1 higher versus lower optimism quintiles= -4.1%, 95%CI: -11.2, 3.6). The association between optimism and lifespan was null across all sociodemographic strata as well.

CONCLUSION

Contrary to the existing evidence from Western populations, optimism was unrelated to longevity among Japanese older adults. The association between optimism, as evaluated by the LOT-R, and longevity may differ across cultural contexts.

Characteristics associated with optimistic or pessimistic perception about the probability of contracting COVID-19: A cross-sectional study of Japanese older adults

Introduction

Excessive optimistic perception about the probability of acquiring coronavirus disease (COVID-19) may hinder people from exercising preventive measures, whereas excessive pessimistic perception can induce psychological problems. Not much focus has been paid to this topic, and prior studies are only online surveys. We determined the characteristics of older adults with optimistic and pessimistic perceptions of the probability of contracting COVID-19.

Methods

We used data from the Japan Gerontological Evaluation Study (JAGES), including 18,045 participants aged ≥ 65 years (mean age: 75.7 years) who were physically and cognitively independent. Self-reported questionnaires were sent to 11 municipalities between November 2020 and February 2021. Multinomial logistic regression was used for data analysis.

Results

The characteristics of 1,596 (8.8%) participants with optimistic perception and 1,276 (7.1%) with pessimistic perception were compared with that of others (80.4%) with moderate perception. Optimism about infection probability was positively associated with older age; better perceived financial conditions but negatively associated with higher education level; trust in TV news programs, TV information programs, and government-issued newsletters; depressive symptoms; and higher levels of reciprocity. Pessimism was negatively associated with higher levels of social cohesion. In contrast, it was positively associated with engagement in paid work; trust in TV news programs, the Internet, and information from medical staff; and depressive symptoms.

Conclusion

Optimistic and pessimistic perceptions about the probability of acquiring infection correlated differently with various characteristics. Thus, risk communication during a pandemic should be tailored based on specific individual characteristics.

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The perception of COVID-19 infection probability among older adults was studied.

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Older age, lower education and reciprocity were associated with optimism.

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Lower social cohesion, employment and depression correlated with pessimism.

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Trust in information from the TV and Internet was associated with pessimism.

Predictive validity of the modified Kihon Checklist for the incidence of functional disability among older people: A 3-year cohort study from the JAGES

AIM

The original Kihon Checklist, validated to predict the incidence of functional disability, has been modified to capture both functional ability (can/cannot) and performing state (do/do not). However, the predictive validity of the modified Kihon Checklist remains unverified. Therefore, this study intends to verify the predictive validity of the modified Kihon Checklist and to clarify whether predictive discrimination differs between the classification method of functional ability and performing state.

METHODS

The participants comprised 67 398 older people who responded to the Japan Gerontological Evaluation Study (2016). They were followed for 3.1 years on average. Cox's proportional hazards model with incidence of functional disability as the endpoint was used to calculate the hazard ratio, adjusted for sex and age. The independent variables were judged by two classification methods, functional ability and performing state, using nine indicators based on the modified Kihon Checklist. Additionally, we examined whether the two classification methods produced different C-index estimates.

RESULTS

Incidence of functional disability occurred in 6232 participants (9.2%). The adjusted hazard ratio of those to whom the nine indicators applied was significantly higher than that of those to whom they did not. The range of the hazard ratio was 1.50-3.82 for both classification methods. The C-index was slightly higher when the classification was based on performing state than when it was based on on functional ability.

CONCLUSIONS

Although predictive discrimination was slightly higher for the performing state than for functional ability, the predictive validity of the modified Kihon Checklist was confirmed for both. Geriatr Gerontol Int 2022; ••: ••-••.

[Differences in risk of requiring care between screening using queries with and without definitions when determining frequency of going out]

Objectives　This study elucidates the differences in risk for a functional decline in general housebound screening using queries with and without definitions.Methods　This study involved 10,802 community-dwelling older people who lived in four municipalities in Aichi Prefecture. The participants were asked about their frequency of going out in general and for five specific purposes: shopping, hospital visitation, strolling, leisure, and work. A person was defined as being "generally housebound" if he/she answered "less than once per week." However, a query with the definition of "going out" was used in only one of the four municipalities. Furthermore, we defined a person who goes out once a week, for any of the purposes, as "by-purpose non-housebound." If the response to the general and purpose-specific queries were inconsistent, we regarded it as an "inconsistent answer." Additionally, we compared the occurrence rate and hazard ratio for the onset of long-term care insurance certification of general housebound screening using queries with and without definition. We also calculated the occurrence rate and related risk factors for inconsistent answers.Results　The occurrence rate of general housebound screening using query with and without definition was 2.8% and 11.7%, respectively. Additionally, the hazard ratio for the onset of long-term care insurance certification of general housebound screening using the query with definition was 1.56 times more than that of general housebound screening using query without definition. The rate of inconsistent answers in by-purpose non-housebound using query with and without definition was 2.2% and 10.2%, respectively. However, sex, age, living with spouse and child(ren), years of schooling, self-rated health, depression, habitation in islands, and indicating definition of "going out" were related to inconsistent answers. The prevalence ratio of inconsistent answers in respondents using query with definition was significantly lower than among respondents using query without definition (PR=0.29).Conclusion　Query with definition reduced the occurrence rate of general housebound and increased the hazard ratio for the onset of long-term care insurance certification. Therefore, a definition should be added to queries asking for the frequency of going out to screen for housebound.

The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups

Despite rapidly rising health expenditure associated with population aging, empirical evidence on the effects of cost-sharing on older people is still limited. This study estimated the effects of cost-sharing on the utilization of healthcare and health among older people, the most intensive users of healthcare. We employed a regression discontinuity design by exploiting a drastic reduction in the coinsurance rate from 30 to 10% at age 70 in Japan. We used large administrative claims data as well as income information at the individual level provided by a municipality. Using the claims data with 1,420,252 person-month observations for health expenditure, we found that reduced cost-sharing modestly increased outpatient expenditure, with an implied price elasticity of  - 0.07. When examining the effects of reduced cost-sharing by income, we found that the price elasticities for outpatient expenditure were almost zero,  - 0.08, and  - 0.11 for lower-, middle-, and higher-income individuals, respectively, suggesting that lower-income individuals do not have more elastic demand for outpatient care compared with other income groups. Using large-scale mail survey data with 3404 observations for self-reported health, we found that the cost-sharing reduction significantly improved self-reported health only among lower-income individuals, but drawing clear conclusions about health outcomes is difficult because of a lack of strong graphical evidence to support health improvement. Our results suggest that varying cost-sharing by income for older people (i.e., smaller cost-sharing for lower-income individuals and larger cost-sharing for higher-income individuals) may reduce health expenditure without compromising health.

Long-Term Associations between Disaster-Related Home Loss and Health and Well-Being of Older Survivors: Nine Years after the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND

Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors.

OBJECTIVES

We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼9y post-disaster.

METHODS

We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n=3,350 and n=2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available.

RESULTS

After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference=0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes.

DISCUSSION

Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903.

Association between social participation and hypertension control among older people with self-reported hypertension in Japanese communities

Hypertension control remains poor worldwide despite well-established strategies for lowering blood pressure. Social participation has been associated with a lower prevalence of hypertension, but evidence is scarce regarding hypertension control. The aim of this study was to examine the relationship between social participation and hypertension control among older people. We used cross-sectional data from participants of the 2019 wave of the Japan Gerontological Evaluation Study (JAGES; n = 13,629). Social participation was defined as no participation, participation in one group, or participation in two or more groups. After adjusting for covariates, modified Poisson regression analysis showed that participation in two or more groups (prevalence ratio [95% confidence interval]: 1.08 [1.03-1.13]) was associated with better control of hypertension than no participation, but participation in one group (1.02 [0.96-1.08]) was not. Social participation in multiple groups was associated with better control of hypertension among older people in Japan.