Mariko Nishi

Approximately 40% of older adults in Japan express a desire to continue working for as long as possible. In interviews conducted by the authors with member

Our study examined the associations between neighborhood walkability, frailty, and the incidence of long-term care insurance (LTCI) service needs using a prospective cohort survey in a suburban town in Japan. The final sample for analyses comprised 2867 community-dwelling older adults (mean age: 73.0 years). Neighborhood walkability was measured using the Walk Score^®. A total of 387 participants (13.5%) exhibited frailty. The odds of frailty, adjusted for the covariates (sex, age, educational status, marital status, residential status, employment status, subjective economic status) among participants who lived in somewhat walkable/very walkable areas, was 0.750 (95% Confidence Interval, CI: 0.597–0.943) versus those who lived in car-dependent areas. During the 23-month follow-up, 102 participants needed LTCI services (19.0 per 1000 person-years), 41 of whom (21.0 per 1000 person-years) lived in car-dependent areas, and 61 of whom (17.9 per 1000 person-years) lived in somewhat walkable/very walkable areas. As compared with participants who lived in car-dependent areas, the incidence of LTCI service needs was not significantly lower than that of those who lived in somewhat walkable/very walkable areas. Walk Score^® can provide the critical information for the strategies to improve walkability and prevent older adults’ frailty in less walkable areas, contributing to achieving the United Nation’s Sustainable Development Goals (SDGs).

Background: Social contact leads to an increased likelihood of engaging in physical activity (PA). However, the influence of social contact on PA would be different depending on the social contact source. This study aimed to identify the association of changes in social contact with family and non-family members with the change in PA using a parallel latent growth curve modeling. Methods: Participants were randomly selected from among residents in the study area age ≥ 20 years (n = 7000). We conducted mail surveys in 2014, 2016, and 2019. The 1365 participants completed all surveys. PA was assessed with validated single-item physical activity measure. Social contact was assessed by summing frequencies of face-to-face and non-face-to-face contacts with family/relatives not living with the participant and friends/neighbors. Parallel latent growth curve modeling was used to assess the cross-sectional, prospective, and parallel associations of social contact with PA change. Results: There was a positive cross-sectional association between contact with friends/neighbors and PA, whereas prospective and parallel associations between contact with family/relatives and PA. Conclusion: Contacting friends/neighbors did not predict the change in PA, and a high frequency of contact with family/relatives at baseline and increasing contact with family/relatives was associated with increased PA over 5-year.

This study examined differences in older adults’ travel behaviours by frailty status in metropolitan, suburban, and rural areas of Japan. Data were collected from 9104 older adults (73.5 ± 5.7 years; 51% women; 19% frail) living in metropolitan (n = 5032), suburban (n = 2853), and rural areas (n = 1219) of Japan. Participants reported if they walked, cycled, drove a car, rode a car as a passenger, and used public transportation (PT) once per week or more. A standardised questionnaire was used to assess frailty status. We conducted logistic regression analysis to calculate the odds ratios of using each travel mode by frailty status stratified by locality. Relative to non-frail participants, frail participants were less likely to walk and drive a car in all three areas. Frail participants had significantly higher odds of being a car passenger in the suburban (OR = 1.73 (95% CI: 1.32, 2.25)) and rural areas (OR = 1.61 (1.10, 2.35)) but not in the metropolitan area (OR = 1.08 (0.87, 1.33)). This study found that frail older adults living in suburban and rural areas tended to rely more on cars driven by someone else, suggesting that transport disadvantage is more pronounced in suburban and rural areas than in metropolitan areas.

This study aimed to examine area differences in the prevalence of and factors associated with frailty. This cross-sectional study included metropolitan (eastern and western areas), suburban (districts A and B), and rural areas of Japan (n = 9182, woman 50.9%). Frailty was defined by using a standardized questionnaire comprising three subcategories (fall, nutritional status, and social activities). The prevalence of frailty in the five areas was 14.2% to 30.6% for men and 11.5% to 21.4% for women. The areas with a high frailty prevalence had a significantly lower nutritional status or social activity, or both. Compared to the western metropolitan area, among men, the multivariable-adjusted prevalence ratio (APR) of frailty was significantly higher in the eastern metropolitan area and lower in suburban district A, and among women, the eastern metropolitan and rural areas had significantly higher APRs. Area-stratified multiple Poisson regression analysis showed that age, bone and joint disease, and a subjective economic status were associated with frailty in most areas and that some factors were area-specific, i.e., living alone (for men living in metropolitan areas) and underweight (for women living in suburban areas). The frailty prevalence differed by area, even after multivariable adjustment. Area-specific characteristics and factors associated with frailty may result in area differences.

Informal neighbor relationships (NRs) are considered a structural aspect of social relationships. Although NRs might affect physical activity (PA), no previous study has simultaneously examined compositional and contextual associations of NRs with PA. In this study, we examined whether individual- and community-level NRs were independently associated with PA. We analyzed cross-sectional data from 8592 (4340 men and 4252 women) non-disabled residents aged 65–84 years from all 18 districts of Ota City, Tokyo. PA was assessed by using the International Physical Activity Questionnaire-Short Form. In addition, we calculated moderate-to-vigorous PA (MVPA), its components (vigorous PA [VPA], moderate PA [MPA], and walking time [WT]), and sitting time (ST). Individual-level NRs were categorized as “visiting each other,” “standing and chatting,” “exchange of greetings,” or “none.” Community-level NRs were defined as the proportions of residents with active NRs (i.e., those in the categories visiting each other and standing and chatting) in the 18 districts. Using multilevel regression analyses, we examined independent associations of individual- and community-level NRs with PA variables and adjusted for important confounders. Individual-level NRs were consistently positively associated with MVPA and its components (VPA, MPA [in men], and WT) in both sexes, and the dose–response relationships were significant (all P < 0.041 for trend). In men, community-level NRs (by 1% estimation) were positively associated with individual MVPA (2.1 metabolic equivalent-hours/week, 95% confidence interval: 0.7–3.4), VPA (8.6 min/week, 2.7–14.4), and WT (11.6 min/week, 2.2–20.9), regardless of the degree of individual-level NRs. Significant cross-level interactions of NRs with MVPA and VPA were observed among men, and the dose–response relationships were significant (both P < 0.037 for trend). Neither individual- nor community-level NRs were associated with ST in either sex. Men and women with inaccessible neighbors engaged in less MVPA, while men living in communities with active NRs engaged in more MVPA, regardless of individual-level NRs. NRs at the individual and community level might help prevent physical inactivity among men.

We reported previously that a 10-year community intervention for disability prevention successfully extended healthy life expectancy at 70 years and decreased the enrollment rate of the Long-Term Care Insurance in Kusatsu, Gunma Prefecture, Japan. In order to clarify functional factors that contributed to healthy aging, this study examined changes in physical, nutritional, psychological and social functions in older adults who participated in annual health checkups over the period. Data sources were participants in annual health checkups conducted from 2002 to 2012 and respondents to biannual monitoring surveys conducted from 2003 to 2011. The target population was all older adults aged 70 years and over living in Kusatsu. The average participation rate over the period was 34.7% for the annual health checkups and 95.0% for the monitoring surveys. First, we examined the representativeness of the participants in annual health checkups by comparing them with the responders to monitoring surveys in terms of their higher-level functional capacity, as measured by the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (Analysis 1). Second, we examined changes in the physical (4 measures), nutritional (3 measures), and psychological and social (4 measures) functions of participants in annual health checkups over the period. In this analysis, we standardized the data for each year on 11 measures to a mean of 0 and a standard deviation of 1.0 using the 2002 data as the standard, and conducted statistical tests for the slopes of the linear approximate equation (intercept=0) (Analysis 2). In Analysis 1, the TMIG-IC scores for participants in the annual health checkups were significantly higher in both sexes than were those for responders to the monitoring surveys. However, there were no significant year×group interactions in the scores. The difference in scores between the two groups was small for participants in their seventies, but large for participants in their eighties or over. Analysis 2 showed that all physical functions improved significantly over the period in both sexes, and the slopes of the linear approximate equation were steeper for maximal and usual gait speeds (slope=0.050 and 0.048, respectively, in men; 0.067 and 0.060, respectively, in women) than for other measures. In women, in addition to physical function, scores on the Mini-Mental State Examination (slope=0.053), Geriatric Depression Scale (slope=0.027), and Social Roll Scale (slope=0.019) also increased significantly. Although participants in annual health checkups were biased toward better functioning, the degree of the bias did not change significantly over the period. During the same period, physical function for both sexes, and psychological and social functions for women, improved significantly. It may be concluded that functional improvement in older adults contributed to the healthy longevity in Kusatsu.

Area Comprehensive Support Centers play critical roles in identifying those elderly not currently using medical or long-term health care services, offering preventative measures against further health crises and possible isolated death. The purpose of this study was to develop an "At-Risk Elderly Checklist." This checklist can help in identifying those at-risk elderly, allowing people in communities to provide the Area Comprehensive Support Center with information about at-risk elderly. As a preliminary step, interviews were conducted with 29 professionals who work for 17 different Area Comprehensive Support Centers located in 4 municipalities around the Tokyo Metropolitan Area. We constructed 23 items based on the findings of this preliminary research and existing tools used in different areas. These items represented distinctive characteristics of elderly who need support from Area Comprehensive Support Centers in order to receive necessary medical and long-term care services. A self-report survey was conducted on 109 professionals of 20 Area Comprehensive Support Centers of Ota-ku, Tokyo in order to examine the content validity of the items. Using factor analysis, we identified 5 factors consisting of 19 items. The first factor consisted of 5 items helping people to identify a serious health crisis from the appearance and condition of the elderly individual's home. The health crisis indicated by these items might require immediate hospitalization. The second factor consisted of 5 items that can help people notice symptoms of dementia through their communication with elderly. The third factor consisted of 4 items useful for assessing health deterioration of the elderly by observing various behaviors. The fourth factor consisted of 3 items that people can use to measure the progress of dementia, including issues with how the elderly dressed themselves. The fifth factor consisted of 2 items that can be used to understand signs of declining health or the progress of dementia by paying attention to the elderly individuals' body odor and personal appearance. From the original 19 items, 14 that were considered the most useful in detecting at-risk elderly were selected based on a frequency distribution. The content validity of 14 items was confirmed by 20 professionals from Area Comprehensive Support Centers in Outa-ku. This checklist may be effective in the early detection of elderly at risk of serious health crises and isolated death due to not using necessary medical and long-term care services.