Social participation and the combination of future needs for long-term care and mortality among older Japanese people: a prospective cohort study from the Aichi Gerontological Evaluation Study (AGES)

Social participation and functional disability trajectories in the last three years of life: The Japan Gerontological Evaluation Study

BACKGROUND

Functional disability has various patterns from onset until death. Although social participation is a known protective factor against functional disability among older individuals, it is unclear whether social participation is associated with the trajectory patterns of functional disability prior to death. This study assessed the association between social participation, specifically in horizontal and vertical groups, and the trajectories of functional disability prior to death.

METHODS

We used survey data from the 2010 Japan Gerontological Evaluation Study for functionally independent older adults combined with public long-term care insurance system data from 2010 to 2016 (n = 4,502). The outcome variables included five previously identified trajectory patterns using group-based trajectory modeling. As the explanatory variable, we used three definitions of social participation: any group, horizontal group (e.g., sports, hobbies), or vertical group (e.g., political, religious), at least once a month. We used a multinomial logistic regression analysis to calculate odds ratios with 95 % confidence intervals for the identified trajectory patterns.

RESULTS

Participation in any groups was significantly less likely to belong to "Accelerated disability" (OR=0.74 [95 % CIs 0.60-0.92]), "Persistently mild disability" (0.68 [0.55-0.84]), and "Persistently severe disability" (0.67 [0.50-0.83]) compared to "Minimum disability." Although participation in horizontal groups was similarly associated with trajectories regardless of gender, vertical groups was not associated with trajectories among males.

CONCLUSIONS

Social participation among older adults may be associated with an extended period of living without disabilities before death. This association may differ by gender and social participation group and requires further research.

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.

Social participation and incident disability and mortality among frail older adults: A JAGES longitudinal study

BACKGROUND

Frailty is the highest risk factor for incident disability and mortality. Social participation is a modifiable factor for reducing adverse outcomes among independent older adults. However, the association between social participation and incident disability and mortality among frail older adults remains unclear. Therefore, we examined the association between various social activities and incident disability and mortality.

METHODS

This nationwide prospective cohort study (The Japan Gerontological Evaluation Study) recruited older adults with frailty, aged 65 years and older (N = 9090) who were followed up for 6 years (2010-2016). We examined incident disability and all-cause mortality at the end of the follow-up period. Frailty was assessed using the Kihon Checklist. The independent variable was social participation in 2010, grouped into the following seven categories: hobby groups, sports groups or clubs, volunteer groups, senior citizens' clubs, industries, neighborhood communities, and paid work.

RESULTS

The incidence of disability among participants was 19.5% (1770) and that of mortality was 19.2% (1753). Belonging to sports groups or clubs (Hazard Ratios [HR] = 0.74; 95% Confidence Interval [CI] = 0.57, 0.98) or hobby groups (HR = 0.77; 95% CI = 0.60, 0.98) was significantly associated with a lower risk of incident disability. Meanwhile, hobby groups (HR = 0.68; 95% CI = 0.56, 0.83), sports groups or clubs (HR = 0.71; 95% CI = 0.57, 0.88), volunteer groups (HR = 0.69; 95% CI = 0.54, 0.88), and senior citizens' club (HR = 0.75; 95% CI = 0.61, 0.90) were associated with lower risk of incident mortality.

CONCLUSIONS

Social participation was associated with a lower risk of incident disability and mortality, not only in healthy older adults but also in frail older adults who are at higher risk of incident disability and mortality. This suggests that frail older adults should be encouraged to participate in all the seven types of social participation examined in this study, as this may lower the risk of subsequent disability and mortality.

Content comparison of long-term care instruments based on the international classification of functioning, disability and health (ICF)

BACKGROUND

Ageing poses a huge challenge to the Chinese social welfare system. However, a national long-term care (LTC) instrument has not been established yet. This study aimed to analyse and compare the content of six selected LTC instruments based on the linkage of the International Classification of Functioning, Disability and Health (ICF) to provide a content reference from a functioning perspective for the development of a Chinese national LTC instrument.

METHODS

Two trained health professionals performed the linkage analysis according to the refined ICF linking rules. The main concepts included in the items of three international LTC instruments, namely Minimum Data Set 3.0 (MDS 3.0), Initial Assessment Instrument (IAI), and New Assessment Tool for Determining Dependency on Nursing Care (NBA), as well as three Chinese instruments, namely Disability Assessment of Long-Term Care (DA-LTC), Specification for Elderly Care Unified Need Assessment in Shanghai Version 2.0 (SEC-UNA 2.0), and pictorial-based Longshi Scale (LS), were selected and linked to the ICF categories. The six selected LTC instruments were analysed and compared at the levels of ICF components, chapters, and categories.

RESULTS

The main concepts of 340 items of the six LTC instruments were linked to 112 different ICF categories. Within the ICF framework, the 'Activities and Participation' component was most frequently addressed in the LTC instruments, followed by 'Body functions', at 52% and 38%, respectively. At the chapter level, 'b1 mental functions', 'd4 mobility', and 'd5 self-care' were addressed by the majority of LTC instruments.

CONCLUSION

The ICF provides a general reference for the analysis and comparison of different LTC instruments. The findings indicate that all LTC instruments focused on older adults' physical needs; however, various important issues regarding their psychological and social participation needs were not addressed. Specific for China, the core elements of LTC instruments varied, and the ICF chapters 'b1', 'd4', and 'd5' are recommended to develop a national uniform one.

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

Social Relationships and Onset of Functional Limitation among Older Adults with Chronic Conditions: Does gender matter?

Objectives

This study aimed to examine the longitudinal association between social relationships and physical functioning among community-dwelling older adults with chronic conditions.

Methods

Self-reported questionnaires were distributed and collected between 2014 and 2017 from participants ≥65 years old. The Index of Social Interaction was used to evaluate social relationships and the instrumental activities of daily living (IADL) subscale of the Tokyo Metropolitan Institute of Gerontology Index of Competence was used to examine functional status.

Results

A total of 422 participants (190 males and 232 females) were included in the final analysis. High social relationships demonstrated significant adverse effects (odds ratio [OR] = 0.77, 95% confidence interval [CI]: 0.64-0.93) on the decline of IADL in the overall sample, particularly for females (OR = 0.71, 95% CI: 0.55-0.93) but not as much for males (P = 0.131).

Conclusion

This finding suggests that functional limitation was influenced by social relationships among disabled older adults and the influence of social relationships on functional limitation differed based on gender.

Association between the Standardized Mortality Ratio and Healthy Life Expectancy in Japan

Introduction

Healthy life expectancy (HLE) remains the principal target of various health plans. We aimed to identify the areas of priority and determinants of mortality to extend HLE across local governments in Japan.

Methods

HLE according to secondary medical areas was calculated using the Sullivan method. People requiring long-term care of level 2 or higher were considered unhealthy. Standardized mortality ratios (SMRs) for major causes of death were calculated using vital statistics data. The association between HLE and SMR was analyzed using simple and multiple regression analyses.

Results

The average (standard deviation) HLE values were 79.24 (0.85) and 83.76 (0.62) years for men and women, respectively. A comparison of HLE revealed regional health gaps of 4.46 (76.90-81.36) and 3.46 (81.99-85.45) years for men and women, respectively. The coefficients of determination for the SMR of malignant neoplasms with HLE were the highest and were 0.402 and 0.219 among men and women, respectively, followed by those of cerebrovascular diseases, suicide, and heart diseases among men and those of heart disease, pneumonia, and liver disease among women. When all major preventable causes of death were analyzed simultaneously in a regression model, the coefficients of determination were 0.738 and 0.425 among men and women, respectively.

Conclusions

Our findings suggest that local governments should prioritize preventing cancer deaths via cancer screening and smoking cessation measures in health plans, with a special focus on men.

Employment in old age and all-cause mortality: A systematic review

Social participation promotes and maintains the health of older adults. Working is a type of social participation; however, the effect of employment in old age on health outcomes has not been established. This study aimed to review the relationship between employment in old age (≥60 years) and all-cause mortality. For this systematic review, a computerized search was performed using PubMed, CINAHL and PsycINFO for prospective studies published through June 2020. The observational studies were extracted according to the study participants, indicators, follow-up period, statistical approach and main results. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Of the 37 832 records identified, 14 studies were included in the systematic review based on the inclusion and exclusion criteria. Eight studies were derived from Asian countries (four from Japan, two from Taiwan and one from Thailand and South Korea), three were from the United States, two were from Israel and one was from Brazil. The baseline data of 13 studies were collected before 2000. Thirteen of the 14 studies reported any association between employment in later life and a lower risk of mortality. Four studies examined the sex-related differences in the effect of later-life employment on all-cause mortality, but the association was controversial. Overall, we revealed that working in old age would lower mortality risk. Although more findings based on recent data are required, this study indicates that working later in life is beneficial for promoting and maintaining health. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

Research Types and New Trends on the Omaha System Published From 2012 to 2019: A Scoping Review

The Omaha System is a popular and standard term used in community health. This scoping review aimed to update the research types and identify new usage trends for the Omaha System through articles published between 2012 and 2019. The bibliography databases PubMed, CINAHL, Scopus, PsycInfo, Ovid, and ICHUSHI and the Omaha System's Web site were used to search for publications. Research articles published between 2012 and 2019 that included "Omaha System" in the title or abstract and were written in English or Japanese were included in this review. After excluding duplicate articles, 305 articles were screened and 82 were included in our analysis. There was a median of 10.3 articles per year. The percentages for each type of use of the Omaha System to "analyze client problem," "analyze clinical process," "analyze client outcomes," and "advanced classification research" were 18.3%, 12.2%, 23.2%, and 4.9%, respectively. The reclassification of the type "others" (41.5%) included "use the Omaha System data for assessment for other than clients," "use the Omaha System data as structured data," "encode by the Omaha System code," "adopt the OS framework," "clinical information system," and "literature review." This newly reclassified category will help capture future research trends using the Omaha System.

Effectiveness of a community organizing intervention on mortality and its equity among older residents in Japan: A JAGES quasi-experimental study

Interventions that involve key aspects of community organizing, such as quantitative community assessments and organizational partnership support for the community, may promote residents' health. We evaluated the effectiveness of this form of intervention on mortality and its variability across individual-level household equivalized income tertiles, comparing 52,858 residents aged 65 and above in 12 intervention municipalities to 39,006 residents in nine control municipalities in Japan. During 1,166 days of follow-up, the adjusted hazard ratio for cumulative mortality among men in the intervention municipalities was 0.92 (95% confidence interval: 0.86, 0.99) compared to those in the control group, with similar results being observed across all income levels. Active utilization of data to evaluate communities and building intersectoral partnerships might lower older male residents' mortality risk, regardless of their income status.

Impact of the Changes in the Frequency of Social Participation on All-Cause Mortality in Japanese Older Adults: A Nationwide Longitudinal Study

Previous studies have shown that more frequent social participation was associated with a reduced risk of mortality. However, limited studies have explored the changes in the frequency of social participation in older adults. We investigated the impact of the changes in the frequency of social participation on all-cause mortality in Japanese older adults aged 60 years and older. The current study, conducted as a secondary analysis, was a retrospective cohort study using open available data. The participants were 2240 older adults (45.4% male and 54.6% female) sampled nationwide from Japan who responded to the interview survey. Changes in the frequency of social participation were categorized into four groups (none, initiated, decreased, and continued pattern) based on the responses in the baseline and last surveys. The Cox proportional-hazards model showed a decreased risk of all-cause mortality in decreased and continued patterns of social participation. Stratified analysis by sex showed a decreased risk of mortality in the continued pattern only among males. The results of the current study suggest that the initiation of social participation at an earlier phase of life transition, such as retirement, may be beneficial for individuals.

A conceptual analysis of older adults' empowerment in contemporary japanese culture

BACKGROUND

Empowerment among older adults is a key concept for improving their health. In contrast, empowerment evolves according to cultural and historical contexts and needs to be consistently tested and constructed. The purpose of this study was to clarify the components of older adults' empowerment in contemporary Japan and to reconstruct the definition of empowerment.

METHODS

A conceptual analysis was performed using Rodgers' evolutionary method. The data sources were PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, and Igaku Chuo Zasshi. The search keywords were "empowerment," "older adults," and "Japan/Japanese." Of the 8811 articles published between 2000 and 2019 that focused on older adults' empowerment, we selected 60 articles that met our objectives.

RESULTS

Seven antecedents, six attributes, and seven consequences were identified. Older adults' empowerment in contemporary Japan was defined as "the series of processes in which disclosing oneself, not only verbally but also nonverbally (e.g., through work, roles, and collaborative activities), in connection with others, objectively perceiving one's existence and challenges, taking proactive actions based on decision-making, and utilizing one's strengths in new work and community life."

CONCLUSIONS

This concept is useful in practice, education, and research on community development and providing support for older adults based on self-help and mutual aid, not only in Japan but also for the global aging society.

An Overview of Social Participation in Older Adults: Concepts and Assessments

In older adults, social participation is an important component of rehabilitation and health promotion. Several studies have attempted to describe the definition and concepts of social participation, and there were many outcomes to measure social participation. This overview provides information about representative social participation and related concepts that have been defined in the literature. A standardized definition of social participation has not been developed; commonly, recognition for social participation was proposed as focused on involvement in social activities that provide interaction with others in a society or community. Many instruments assess the various aspects of social participation. Because of operational definition and diversity in social participation, performance in social participation was adopted as an aspect of assessment. Further discussions are needed to clarify the definition of social participation and evaluate the instruments used to assess social participation for it to be useful for rehabilitation and health promotion. In doing so, determining and developing assessment and intervention based on the purpose or perspective of social participation in older adults with and without disabilities is important.

Social participation and mortality according to company size of the longest-held job among older men in Japan: A 6-year follow-up study from the JAGES

OBJECTIVES

The purpose of this study was to examine the relationship between social participation (type/pattern) and mortality according to company size of the longest-held job among older men in Japan who have worked in the company.

METHODS

Longitudinal data from the Japan Gerontological Evaluation Study were used in this study. Functionally independent individuals aged 65 years and older in Japan were surveyed. Work and community organizations (local community, hobbies, and sports) were used as social participation. A Cox proportional hazards model was used to calculate mortality hazard ratios.

RESULTS

Analysis was carried out on 19 260 participants. A total of 2870 deaths occurred during the 6-year follow-up period. Those in companies with 49 or fewer employees had the highest prevalence of work participation and the lowest participation in any community organization. Regardless of company size, the mortality risk was significantly lower for participants in any social participation (eg, the hazard ratio for participation in a hobby organization among those with a company size of 49 employees or fewer was 0.74, 95% CI: 0.65-0.85) compared to nonparticipants whose company size was 49 or fewer employees.

CONCLUSIONS

In Japan, although older men who have worked for small companies may have fewer benefits, their social participation may reduce their mortality risks. To avoid increasing health inequalities, it is necessary to create an environment in which they are more likely to participate in social activities.

Multimorbidity and functional limitation: the role of social relationships

OBJECTIVES

To examine the relationship between multimorbidity and functional limitation, and how social relationships alter that association.

METHODS

This cross-sectional study used data collected by self-reported questionnaires from adults aged 65 years and older living in a rural area in Japan in 2017. This analysis included complete data from 570 residents. Multimorbidity status was defined as having two chronic diseases exist simultaneously in one individual, and the function status was measured by their long-term care needs. Social relationships were assessed by the Index of Social Interaction and divided into high and low levels. Multiple logistic regression analysis was used to examine the association between social relationships and functional limitation and to assess the role of social relationships in this association.

RESULTS

The logistic regression model indicated that the risk of functional limitation was higher in multimorbidity participants than free-of-multimorbidity participants (OR = 2.55, 95% CI = 1.56-4.16). Compared with participants with no multimorbidity and a high level of social relationships, low level of social relationships increased the risk of functional limitation among participants both with and without multimorbidity, with the OR = 7.71, 95% CI = 3.03-19.69 and OR = 3.28, 95% CI = 1.30-8.27, respectively. However, no significant result was found in participants with multimorbidity and a high level of social relationships (P = 0.365).

CONCLUSIONS

Multimorbidity was associated with functional limitations. However, this association could be increased by a low level of social relationships and decreased by a high level of social relationships.