Kaori Yamaguchi

Healthy ageing requires supportive environments beyond individual behaviors. Community building has gained policy attention, but evidence on how municipal progress in community building relates to individual social capital remains limited. We analyzed data from 91,891 older adults aged ≥ 65 years across 49 municipalities in Japan using the Japan Gerontological Evaluation Study (2019–2022). We examined whether municipal community-building progress in 2020 related to subsequent individual structural and cognitive social capital in 2022, after adjusting for individual-level covariates and social capital in 2019 and municipal-level covariates in fiscal year 2019. We applied multilevel linear regression with individuals nested within municipalities and assessed heterogeneity using a moderator-wide approach. Higher preventive care and daily life support scores and a greater number of community gathering places per 1000 older adults related to higher structural social capital. These associations were consistent across most subgroups, although the association between the number of community gathering places per 1000 older adults and structural social capital was stronger in municipalities with smaller older populations. We found no clear overall association between municipal community-building indicators and cognitive social capital. However, higher living support system scores related to higher cognitive social capital among women and adults aged ≥ 75 years. Municipal community-building efforts related differently to structural and cognitive social capital. Participation-oriented measures showed consistent associations with structural social capital, whereas support-oriented measures related to cognitive social capital more selectively. These findings highlight the importance of aligning community-building strategies with both social capital dimensions and population characteristics to promote healthy ageing.

Objective: This study assessed the current status and quality of long‐term care (LTC) services in five Southeast Asian countries, including Cambodia, Thailand, the Philippines, Malaysia, and Myanmar, amid rising demand due to population aging. Methods: A mixed‐methods approach was used. First, the relationship between population aging and Universal Health Coverage (UHC) was analyzed using demographic and health system data. Semi‐structured interviews were then conducted with key stakeholders involved in care provision for older adults, guided by seven evaluation domains identified through a comprehensive literature review. Results: Findings revealed a positive association between UHC progress and population aging. LTC organization and delivery varied across countries, reflecting disparities in healthcare infrastructure. Home‐based care predominated; however, public service availability and care integration were inconsistent. Dementia care was largely unrecognized and typically managed within households or communities. Use of information and communication technology (ICT) in LTC was minimal or absent. Thailand showed notable progress in linking rehabilitation services to UHC, though workforce shortages and limited access persisted. Preventive care, including frailty prevention, remained underdeveloped. Conclusions: Substantial variation exists in LTC definitions and delivery across Southeast Asia. While efforts are underway to strengthen home‐based care, enhance dementia recognition, integrate ICT, and expand rehabilitation, significant challenges remain. Addressing these is vital to ensure equitable access to quality LTC for older populations in the region.

Background: Regional health disparities have been reported in many countries, including Japan. As rehabilitation needs increase worldwide owing to population aging and the epidemiological shift from communicable to non-communicable diseases, addressing unmet rehabilitation needs is crucial. Objective: To analyze and compare rehabilitation resources and service provision for older adults across secondary healthcare regions in Japan. Design: A quantitative, analytical cross-sectional design was used in this study. Methods: Nara Prefecture, a representative region in Japan comprising five secondary healthcare regions, was selected as the study setting. Data relevant to rehabilitation were obtained from routine national surveys and the Kokuho local government database for the period April 2019 to March 2020, and retrospectively analyzed as secondary data. The Kokuho database includes medical insurance claims for 213,933 residents aged ≥ 75 years, covering the entire prefectural population in this age group. A descriptive regional comparison was conducted using aggregated administrative data, including age-standardized claims ratios for rehabilitation sessions, to compare secondary healthcare regions. Results: The southern secondary healthcare region, characterized by the smallest population and lowest population density, showed distinctive features. It had the lowest per capita number of rehabilitation beds and professionals across all medical institutions within the region among the secondary healthcare regions. Although the proportion of individuals receiving rehabilitation services was the highest, the overall volume of services provided was the lowest, even after adjusting for age and population size. Notably, the provision of outpatient rehabilitation services across all providers within the region was particularly low compared with that in other regions. Conclusions: This study revealed regional disparities in rehabilitation resources and service provision in secondary healthcare regions, highlighting the need for more equitable access. These findings underscore the value of routinely collected administrative and claims data for regional need assessment, particularly for informing evidence-based planning and resource allocation.

Effective strategies must address functional decline among older adults resulting from aging and disease. We investigate the association between the number of different types of activities that older adults engaged in at community gathering places (CGPs) and their subsequent higher-level functional capacity in Japan. We analyzed longitudinal data from the Japan Gerontological Evaluation Study, collected in 2016 and 2019 (n = 6064). The dependent variable was higher-level functional capacity in 2019. The primary exposures included participation in CGPs and the number of activity types in which participants engaged at those places in 2016. Adjusted linear regression models were performed. Engaging in multiple types of activities at CGPs showed a positive association with higher-level functional capacity at follow-up. Stratified analyses indicated that, among participants without baseline limitations, engaging in three or more types of activities correlated with significantly better functional outcomes. Among those with baseline limitations, participating in two types of activities was significantly linked to better higher-level functional capacity. Engaging in a greater variety of activities at CGPs was associated with improved subsequent higher-level functional capacity. These findings highlight the potential for municipal governments to enhance healthy aging by supporting diverse activity offerings at CGPs.

Aim: Homebound status poses considerable risks for adverse health outcomes among older adults. To enhance the comprehensive care system, municipalities have implemented efforts aimed at long‐term care prevention. It is assumed that such efforts may help mitigate homeboundness. Therefore, this study examined the association between municipal long‐term care prevention efforts and homebound status among older adults. Methods: This 3‐year cohort study utilized panel data between 2019 and 2022 from the Japan Gerontological Evaluation Study (JAGES), involving adults aged ≥ 65 years who were not homebound in 2019. As proxies for municipalities' prevention efforts, the Daily Living Support System Development Progress (DLSSDP) scores and Long‐term Care Prevention and Daily Living Support Progress (LCPDLSP) scores in 2019 were used as explanatory variables. The outcome was homebound status in 2022. Individual‐ and municipality‐level characteristics in 2019 were included as confounders. Multilevel logistic regression with multiple imputation was performed to estimate odds ratios for the association between each score and homebound status. Results: The study included 89 914 participants (female: 51.6%, mean age: 76.5 years). The overall incidence of homebound status in 2022 was 2.8%, with variations ranging from 1.3% to 6.4% across 49 municipalities. Compared with older adults in municipalities with high DLSSDP scores, those in municipalities with low scores had significantly higher odds of being homebound (odds ratio: 1.22; 95% confidence interval: 1.04–1.44). There were no significant differences in homebound odds across municipalities with varying LCPDLSP scores. Conclusion: Living in municipalities with higher DLSSDP scores was associated with not being homebound.

Background: The outbreak of COVID-19 in 2019 led governments worldwide to introduce various public health measures, which included restrictions on travel and public gatherings, effectively reducing the spread of the virus and associated mortality rates. In Japan, nonlegally binding restrictions on outings effectively curbed infections, as in other countries. However, the restrictions impacted lifestyles, including reduced physical activity, increased frailty, and overeating issues, beyond the effect of preventing the spread of infection. Various factors such as personality, age, and cultural norms influenced outing behavior during the pandemic, which varied by activity type. Objective: To elucidate the association between personality traits and changes in outing behaviors during the COVID-19 pandemic, as well as to clarify age-specific differences in outing behaviors, focusing on different types of outings. Methods: A cross-sectional survey was conducted using a web-based questionnaire in January 2021, when Japan announced its second emergency declaration during the pandemic. Overall, 1236 participants were recruited, with an equal number of participants for each gender and 10-year age group. The survey included questions regarding changes in the frequency of three types of outings—medical institution visits, eating out, and traveling—in addition to participants’ personality traits, such as sociability and morality. Multinomial logistic regression analysis was performed to analyze the association between personality traits and changes in different outing behaviors. Stratified analysis by age group was also performed. Results: The findings revealed that 790 participants reported no change in medical institution visits, although the frequency of eating out and traveling decreased during the pandemic. Regarding an age-wise comparison, a higher percentage of older people reported no change in medical institution visits but reported a decrease in eating out and traveling than younger people. Multinomial logistic regression analysis stratified by age showed that sociable people were more likely to report a decrease in the frequency of medical institution visits and an increase in the frequency of eating out (odds ratio [OR] 1.92, 95% CI 1.36‐2.71, P<.001; OR 2.57, 95% CI 1.19‐5.54, P=.016, respectively), and participants with a strong sense of responsibility were more likely to report a decrease in the frequency of traveling (OR 1.76, 95% CI 1.14‐2.72, P=.011) among younger adults. Among older adults, strongly responsible individuals were less likely to eating out frequently (OR 2.56, 95% CI 1.12‐5.82, P=.026). Conclusions: We examined various behavioral changes observed during the pandemic for different types of outings and their associations with personality traits, as well as differences between age groups. The findings could help promote an understanding of how to effectively communicate and engage in appropriate behaviors in public health emergency settings.

The purpose of this study was to examine the relationship between the number of program types and CGA in community gathering places to gain valid insights into the provision of programs in community gathering places. The study was longitudinal in nature and used prospective cohort data from the Japan Gerontological Evaluation Study. The participants were 8758 older adults recruited from 28 cities and towns. The dependent variable was the CGA using the KCL. The independent variable was the number of program types in community gathering places. The participants were classified under four groups, namely, No Participation, One Type, Two Types, and More Than Three Types. The study performed linear regression analysis. The mean of the KCL scores by the number of types was 3.8 ± 3.3, 3.5 ± 3.0, 3.3 ± 2.9, and 3.2 ± 2.8 points for the four groups, respectively. CGA was better for two and three or more types of program participation. CGA at 3 years was better when the community gathering places implemented two or more types of program.

The demographic transition towards an ageing population and the epidemiological transition from communicable to noncommunicable diseases have increased the demand for rehabilitation services globally. The aims of this paper were to describe the integration of rehabilitation into the Japanese health system and to illustrate how health information systems containing real-world data can be used to improve rehabilitation services, especially for the ageing population of Japan. In addition, there is an overview of how evidence-informed rehabilitation policy is guided by the analysis of large Japanese health databases, such as: (i) the National Database of Health Insurance Claims and Specific Health Checkups; (ii) the long-term care insurance comprehensive database; and (iii) the Long-Term Care Information System for Evidence database. Especially since the 1990s, the integration of rehabilitation into the Japanese health system has been driven by the country’s ageing population and rehabilitation is today provided widely to an increasing number of older adults. General medical insurance in Japan covers acute and post-acute (or recovery) intensive rehabilitation. Long-term care insurance covers rehabilitation at long-term care institutions and community facilities for older adults with the goal of helping to maintain independence in an ageing population. The analysis of large health databases can be used to improve the management of rehabilitation care services and increase scientific knowledge as well as guide rehabilitation policy and practice. In particular, such analyses could help solve the current challenges of overtreatment and undertreatment by identifying strict criteria for determining who should receive long-term rehabilitation services.