Age trajectories of disability development after 65: A comparison between Japan and Taiwan

Breaking the vicious cycle: Reciprocal influences between social isolation and functional disability and the buffering effect of digital inclusion

In aging societies like Japan, social isolation (SI) and functional disability (FD) critically impact older adults' health, yet their bidirectional relationship and potential moderators remain underexplored. This prospective cohort study examined the bidirectional SI-FD association and tested digital inclusion's (DI) moderating role among community-dwelling Japanese older adults. We analyzed 480 adults aged ≥65 across three waves (baseline, 3-year, 6-year follow-ups) using multi-group random intercept cross-lagged panel models (RI-CLPM) to disentangle within-person and between-person effects. At the between-person level, SI was positively connected with FD (β = 0.50, p < 0.001). Within individuals, SI and FD demonstrated reciprocal worsening over time, with SI's cross-lagged effect on subsequent FD (T1→T2: β = 0.42, p < 0.001; T2→T3: β = 0.40, p < 0.001) exceeding FD's effect on SI (T1→T2: β = 0.21, p < 0.01; T2→T3: β = 0.29, p < 0.01). DI significantly attenuated SI's adverse impacts: in the digitally included group (n = 291), SI's autoregressive effects and cross-lagged effects on FD became nonsignificant (p > 0.05), SI's cross-lagged effect on subsequent FD also weakened (T1→T2: β = 0.19, p < 0.05; T2→T3: β = 0.22, p < 0.05). Findings suggest bidirectional SI-FD links are partially mitigated by digital engagement. While social interventions remain critical, integrating digital literacy programs may disrupt SI's cascading effects on disability. Study limitations include regional sampling and self-reported measures. Future research should validate these mechanisms across diverse populations and explore targeted digital-social hybrid interventions.

Reversed loneliness development after age 65 for men and women: Modeling of the age trajectories of loneliness using national cohorts in Taiwan and Japan

AIM

This study depicts the age trajectories of loneliness and gender differences among older adults in Taiwan and Japan.

METHODS

Two nationally representative data sets for older adults in Taiwan and Japan were obtained from the Taiwan Longitudinal Study on Aging (TLSA, 1996-2011) and the National Survey of the Japanese Elderly (NSJE, 1996-2012), respectively. The analytic sample included 3037 and 1974 older adults aged 65 and over at baseline in Taiwan and Japan, respectively.

RESULTS

The prevalence rate of loneliness for adults aged 65+ living in the community was 23.64% in Taiwan and 17.03% in Japan. Higher average levels (βTaiwan = 0.1508, P < 0.001) and rates of increment (βTaiwan*age = 0.0068, P < 0.05) in loneliness development were found in Taiwan as compared with Japan. In addition, although women reported higher levels of loneliness compared with men at age 65 (29.0% vs. 19.4% in Taiwan, and 19.3% vs. 13.9% in Japan), a soaring development of loneliness with accelerated rates of increment after age 65 was observed in men in both countries.

CONCLUSIONS

Lonliness in old age is very different between men and women. Women's loneliness curve shows an inverted U state: Although they feel more lonely than men during midlife, it has a downward trend as they get older. On the contrary, men's loneliness curve shows an upward U-shaped curve: After retirement, both Japanese and Taiwanese men continue to rise. Geriatr Gerontol Int 2025; 25: 620-627.

What Are Culturally Relevant Activities of Daily Living in the Asian-Indian Population? A Survey of 402 Patients With Knee Pain

BACKGROUND

Patient-reported outcome measures are essential tools in assessing clinical outcomes. Although several patient-reported outcome measures such as the Oxford Knee Score and Knee Injury and Osteoarthritis Outcome Score have been developed and validated, their applicability in the Asian-Indian population may be limited; key cultural differences including varying functional demands, ethnicity-specific necessities, and social expectations represent a unique collection of needs. Such differences include preferences toward ground-level activities and those favoring the manual completion of tasks.

QUESTIONS/PURPOSES

(1) Which activities of daily living (ADLs) do patients in an Asian-Indian population consider the most important? (2) How do the categories of ADLs (personal care, household, work, travel, and recreation) vary among patients of different gender (men and women) and age (< 60 and > 60 years) groups?

METHODS

A cross-sectional study was conducted in October 2019 at a hospital in Mumbai, India. We developed a questionnaire with five domains for physical activity (personal care, household, work, travel, and recreation) formulated from a review and modification of existing categories identified by the WHO and the American Heart Association. Forty key ADLs were identified according to input obtained from detailed interviews of healthcare providers involved in the care of patients with orthopaedic illness, based on established domains. Respondents were instructed to identify the ADLs that were the most relevant to their lifestyle and culture. Responses from 402 patients (mean age 60 ± 12 years; 51% [206 of 402] were women) were analyzed to identify the most commonly selected ADLs. Responses were further evaluated to understand the impact of gender and age on these preferences by comparing men and women, as well as younger (age < 60 years) and older (age > 60 years) patients.

RESULTS

The three most frequently reported ADLs in each domain, representing the ADLs that were the most important to the Asian-Indian population, were standing without assistance (82% [331 of 402]), getting up with support (81% [324 of 402]), and toilet use (74% [298 of 402]) in the personal activity category; climbing stairs (80% [322 of 402]), sitting cross-legged (80% [320 of 402]), and praying (79% [319 of 402]) in the household activity category; going to the market (72% [291 of 402]), long-distance walking (62% [250 of 402]), and carrying a shopping bag (60% [242 of 402]) in the work activity category; walking on an uneven surface (66% [266 of 402]), using a taxi (61% [247 of 402]), and traveling by train (59% [239 of 402]) in the travel activity category; and yoga (67% [269 of 402]), playing with children (66% [264 of 402]), and indoor games (63% [252 of 402]) in the recreational activity category. The order of importance of ADL domains was identical in the men versus women groups as well as in the younger age versus older age groups; ADL domains with the highest number of selected ADLs in order of decreasing importance were household care, personal care, work, travel, and recreation when analyzed by individual gender and age groups. Women were more likely than men to report the following ADLs as being important: climbing stairs (84% [172 of 206] of women and 77% [150 of 196] of men), getting up without support (83% [171 of 206] of women and 78% [153 of 196] of men), going to the market (74% [152 of 206] of women and 71% [139 of 196] of men), walking on uneven surfaces (67% [139 of 206] of women and 65% [127 of 196] of men), and playing with children (72% [148 of 206] of women and 59% [116 of 196] of men).

CONCLUSION

The findings of this study aim to help providers engage in personalized and socioculturally relevant discussions about knee arthritis. Highlighted areas of importance may facilitate a more comprehensive preoperative discussion of total joint arthroplasty expectations in the context of the needs and demands of Asian-Indian patients. The findings of this study could establish the groundwork for the development of ethnicity-specific patient-reported outcome measures by incorporating the identified ADLs in novel metrics with validation of face and content validity.Level of Evidence Level III, prognostic study.

Trends and biopsychosocial correlates of physical disabilities among older men and women in Taiwan: examination based on ADL, IADL, mobility, and frailty

Background

This study examines correlates of disabilities related to ADL, IADL, mobility, and frailty in men and women with a nationally representative sample of older adults living in the community.

Methods

A total of 10,898 noninstitutionalized Taiwanese nationals aged 65 years and older enrolled in the 2001 (N = 2,064), 2005 (N = 2,727), 2009 (N = 2,904), and 2013 (N = 3,203) National Health Interview Survey (NHIS) were analyzed.

Results

The prevalence of mobility disabilities and frailty in older adults in Taiwan decreased during the past decade (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }_{Mobility}^{2}= -5.4$$\end{document}χMobility2=-5.4, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }_{Frailty}^{2}= -6.2$$\end{document}χFrailty2=-6.2). Exercise, social engagement, and tea and coffee intake were found to be associated with lower levels of all types of disabilities in both men and women. In addition, a diet based on carbohydrates, falls, depressive symptomatology, lung and metabolic diseases were risks for most of the disabilities under consideration. Gender-specific independent correlates included: being married (OR = 0.63, 95%CI: 0.40–0.98), eggs/beans/fish/meat consumption (OR = 0.35, 95% CI = 0.16–0.80); depressive symptoms, obesity and cataracts, which were associated with higher IADL (OR = 3.61, 1.63, and 1.18, respectively) and frailty limitations (OR = 10.89, 1.27, and 1.20, respectively) in women. Cognitive impairment was found to be an important correlate for ADL limitations in men (OR = 3.64, 95%CI: 2.38–5.57).

Conclusions

Exercise, social participation and diet (more tea and coffee intake and lower carbohydrates) were correlates for lower levels of disability. Some gender-specific correlates were also identified, including associations of disability with depressive symptoms, obesity, and cataracts that were more distinct in women, and lower levels of disability which were especially significant in men who were married, eat more eggs, beans, fish, and meat, and those free from cognitive impairment.