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Objectives　In recent years, the Japanese government has promoted a livelihood support system based on residents-based mutual help in the community. This study aimed to examine the associations between the need for livelihood support and the relationship with community residents among older adults who do not use livelihood support in a rural area. We operationally defined livelihood support as helping older adults with daily problems so that they can continue to live in familiar neighborhoods.Methods　A self-administered questionnaire survey was conducted in Gejo Area of Tokamachi City, Niigata Prefecture in October 2018. The questionnaires were distributed to all 1,033 residents aged 65 years or over, excluding those certified with care levels 3-5 in the long-term care insurance system. The survey items included basic characteristics, health status, relationship with community residents, and need for 33 livelihood support items.Results　A total of 802 questionnaires were returned (response rate of 77.6%), and 653 community-dwelling individuals who had not used livelihood support were included in the analysis. Factor analysis grouped the 33 livelihood support items into four factors: temporary problems and troubles (53.4%), participation in events and gatherings (38.0%), daily household chores (31.7%), and small problems in daily life (27.7%). Logistic regression analysis showed that the need for assistance with temporary problems and troubles was related to "low trust in community residents," "willing to help community residents but have not yet done so," and "willing to help community residents and have already done so." The need for assistance with participation in events and gatherings was related to "willing to help community residents but have not yet done so," "willing to help community residents and have already done so," and "higher levels of sekentei." The need for assistance with daily household chores was related to "low trust in community residents" and "willing to help community residents and have already done so." Finally, the need for assistance with small problems in daily life was related to "willing to help community residents and have already done so."Conclusion　The need for livelihood support was related to relationships with community residents. To promote the livelihood support system in communities, the relationships between older adults and community residents should be considered.

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.

Objectives　Many local governments and elementary and junior high schools in Japan have conducted a "greeting campaign". This has been done in order to activate communication among local residents, and to instill public spirit and sociability in students' minds. However, few studies have explored the significance of greeting campaigns. The present study investigates greeting in neighborhoods and its relationship with students' spontaneous greeting behavior. The study also seeks to understand the quantity of greeting in daily life and its association with a student's community attachment and helping behavior.Methods　A self-completion questionnaire survey was conducted with 1,346 students studying in the fourth and higher grades at elementary schools, and 1,357 students in the first and second grade at junior high schools. There were 2,692 valid respondents. We performed the following analyses using the data of elementary school students and junior high school students separately. A partial correlation analysis was conducted wherein gender and grade were introduced as control variables. This analysis tested the correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord. A path analysis that tested the relationship between students' greeting behavior, their attachment to residential areas, and helping behavior was also conducted.Results　The results of the partial correlation analysis revealed that there was a positive correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord, regardless of gender and grade. Moreover, the results of the path analysis revealed that the frequency of being greeted was positively associated with community attachment and that the frequency of students' spontaneous greeting behavior was positively associated not only with community attachment but also with helping behavior. The goodness of model fit was high for both the data of elementary school students as well as the data of junior high school students.Conclusion　We found that exchanging greetings with surrounding people in daily life enhanced students' attachment to the community. In particular, we showed that students' spontaneous greeting behavior led to their helping behavior, which supports the significance of recommending greeting at home, school, or in the local community. Since there was a correlation between the frequency of being greeted and the frequency of greeting willingly, we consider that actions of surrounding adults become important to help students acquire spontaneous greeting behavior.

Objective　To explore health-related and socioeconomic factors that can predict future deterioration in Psychological Distress Scale (K6) scores.Method　We conducted a baseline (2010, 2011) self-administered questionnaire survey of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) involving 1,117 participants who had no previous history of cancer or cardiovascular diseases and were not under treatment for hypertension, diabetes, or dyslipidemia. We used the Japanese K6 as an indicator of stress and defined K6≧5 points as a high-stress group and K6<5 points as a low-stress group. A four-year follow-up survey (2014, 2015) was conducted on 1,004 people (follow-up rate of 90%). We excluded 39 participants with missing values, and 185 people whose K6 score was higher than 5 points at baseline. A final total of 780 participants' scores were examined for: gender, age, living situation, physical activity level, average sleep time, as well as the K6 score, the Japanese Hearing Handicap Inventory for Elderly (HHIE-S), and the Japanese Oswestry Disability Index (ODI). We conducted a logistic regression analysis using K6≧5 points at the four-year follow-up survey as the dependent variable and each factor at the baseline survey as the independent variable.Results　Of the 780 subjects analyzed, 132 (16.9%) were highly stressed (K6≧5 points) at the four-year follow-up point. A logistic regression analysis found age (40s/70s) (odds ratio 3.38, 95% confidence interval 1.45-7.86), living situation (single/living together) (odds ratio 1.98, 95% confidence interval 1.07-3.68), and ODI scores (every 1%) (odds ratio 1.05, 95% confidence interval 1.01-1.09), to all be significantly associated with high stress.Conclusion　This study suggests that age, living situation, and ODI scores are related to future stress.

Objectives　Leisure activities are important for older adults, not only to maintain their subjective well-being but also to prevent bedridden states. This study aimed to develop a leisure activity scale for contemporary older adults and examine its psychometric properties, based on a previous study from Iwasa et al. (2018). As people who actively engage in leisure activities are reportedly less likely to experience cognitive decline, the relationship between the scale score and cognitive function should be assessed while developing the scale. Specifically, the study was conducted to examine the reliability of the scale and its factor structure, confirm basic statistical characteristics, examine the scale's gender- and age-based differences, and the relationship between the scale score and cognitive function.Methods　We surveyed Japanese older adults living in a community (aged 70-84 years; N=594) and used data from 306 participants (151 men and 155 women). We developed and administered a scale comprising 11 items that were measured using a 4-point Likert-type scale. Additionally, we used cognitive function scales including the Mini-Mental State Examination (MMSE), the Memory Impairment Screen (MIS), and the Word Fluency Test. Covariates in tests for independent associations between the leisure activity scale score and cognitive function were socioeconomic status, chronic disease, functional capacity, and living alone. We conducted two web surveys with two-week intervals for test-retest reliability purposes and used data from 192 of those participants (aged 70-79 years; 101 men and 91 women).Results　A confirmatory factor analysis upheld the fact that the scale was comprised of one factor. The scale obtained high indicators of reliability: Cronbach's alpha coefficient (0.81) and test-retest reliability (0.81). The mean, standard deviation, median, skewness, and kurtosis of the scale score were 14.44, 7.13, 15, -0.12, and -0.73, respectively. The analysis of variance for the scale score indicated significant age-based differences (i.e., the score for those who were 70-74 years old was higher than for those who were 80-84 years old) and no significant gender differences. Multiple regression analyses demonstrated that the scale score was significantly and independently correlated with MMSE (β=0.31), MIS (β=0.24), and word fluency (β=0.25).Conclusion　This study confirmed the psychometric properties of the leisure activity scale, including factor structure, reliability, basic statistical characteristics, no gender differences, significant age-based differences, and relationship to cognitive function. Future studies should examine the longitudinal relationship between the leisure activity scale score and cognition among older adults in community settings.

Objectives　To examine how parents of children with mental illness prepare for their children's lives in the community after their own death.Methods　Twenty-two parents living in the Kanto region, who have children with mental illness, were interviewed from December 2016 to February 2017. Through qualitative inductive analysis, codes were identified from the narrative data that showed the preparation of parents and compared their similarities and differences. Similar codes were collected and subcategories and categories were created with increasing abstraction levels. Each category was considered with respect to the purpose and the reason why each preparation was done.Results　Participants were 9 fathers (40.9%) and 13 mothers (59.1%). Their ages were as follows: in their sixties (n=9; 40.9%), seventies (n=10; 45.5%), and eighties (n=3; 13.6%).　Ten categories emerged regarding parental preparation for their children's life after their death: 1) Forecasting their own death and recognizing the limitations of support; 2) Trying to share with their children about their own death; 3) With consideration of after their own death, organizing the necessary information for their children and their own belongings; 4) Consulting with their relatives about the lives of their children and inheritance, and considering the use of the social resources; 5) Trying to secure a residence and living expenses for their children; 6) Connecting with social resources, searching for recovery methods for their children, and their own health maintenance; 7) Stabilizing and recovering disease conditions of their children, supporting to take medication and outpatient visits; 8) Assessing the ability of their children to live considering their independent life; 9) Developing their abilities to live and sociality, and making reliable supporters other than parents; 10) Encouraging to have fun in their children's lives and considering their employment. Parents were preparing to hope their child would cope with difficulties in their lives after their own death, and maintain a stable life in the community by him/herself.Conclusions　The results suggested that parents should recognize the need of an independent life for their children in the community, to promote concrete preparations toward their children living in the community after their own death.

Objectives　The aim of this research is to classify elderly adults who live alone by their marital status type and to clarify how those types affect their higher-level functional capacity and mental health with a 2-year follow-up survey.Methods　This research is based on the results from a survey in 2013. The base-line scores were from 757 participants who completed a survey by mail, carried out in B area of A ward, Tokyo, within the jurisdiction of community general support centers, with people who were not at nursing care levels 4 or 5 and who were not residents of welfare facilities. This study analyzed data for 517 of 527 participants, who answered all questions in the 2015 survey and indicated their marital status. This research categorized the respondents into 4 types of marital status: separation, divorce, bereavement, and unmarried groups. This study adopted the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) as the index of higher-level functional capacity, and the WHO-Five Well-Being Index (WHO-5-J) as the mental health index. In the analysis of the causes of 2-year variations in TMIG-IC total scores and WHO-5-J scores, the dependent variable was each variation. This study used an analysis of covariance in which the fixed factors were types of living alone, sex, annual income, and having children who lived separately in the 2013 survey, and the covariance comprised the base-line scores for the dependent variables, age, and chronic diseases in the 2013 survey.Results　With regards to the variation in TMIG-IC total scores, main effects of the types of living alone were observed. The adjusted variation of covariance decreased most in the separation group (-0.95). For the variation in WHO-5-J scores, main effects of the types of living alone were indicated. In the divorce group, the adjusted variation of covariance was significantly higher than for the unmarried group (2.33 vs. -0.55).Conclusion　The results revealed that the types of marital status: separated, divorced, bereaved, and unmarried, affect changes in the higher-level functional capacity and mental health status of elderly adults living alone, 2 years later. Thus, although previously regarded as a single category, types of marital status should be considered in the analysis of elderly adults who live alone.

Objectives　Creating a healthy food environment is crucial for healthful longevity in Japan. This study aimed to provide an overview of the status and challenges related to creating that environment through prefectural public health centers.Methods　Public health dieticians working at 489 prefectural public health centers in March 2015 individually completed an anonymous self-administered questionnaire. Berelson's content analysis was utilized for response analysis.Results　Data from 359 (response rate: 74.3%) prefectural public health centers, involving 599 public health dieticians, were included in the analysis. More than 80% of the prefectural public health centers implemented a registration system for dining facilities such as restaurants. Furthermore, greater than 80% of the public health dietitians thought that creating a healthy food environment was an important aspect of their work mission. On the other hand, more than 50% of these dieticians expressed dissatisfaction in their role. In terms of evaluation, the public health centers only monitored the number of registered facilities, with few other evaluations conducted. Approximately 80% of the participants requested national guidelines and/or some legal support from the Ministry of Health, Labor, and Welfare and/or the prefectural administration.Conclusion　This study demonstrated that there are challenges related to creating a healthy food environment through prefectural health centers. Improving the evaluation methods and government/administrative provision of national guidelines and/or legal supports were identified as courses of action.

This paper explores the history of Yunosawa Village for Hansen’s disease patients in Kusatsu Town, which is famous for its hot springs and located in a mountainous area of Gunma Prefecture, Japan. Yunosawa Village was initially formed by Kusatsu Town government as a settlement for a small number of patients in 1869, but later became the biggest “open leprosy colony” for Hansen’s disease patients in modern Japan. Patients in Yunosawa gradually constructed their own regional community and expanded their presence in Kusatsu as part of the town. Although townspeople in Kusatsu made several attempts to remove patients in Yunosawa to a more remote area away from the town center so that they would be out of sight of visitors, townspeople in Kusatsu had a long history of treating Hansen’s disease patients as customers of the hot springs, which enabled them to understand the nature of the disease through their own experience. This “folk epidemiology” created a “symbiotic” relationship between patients in Yunosawa and townspeople for nearly 60 years until the national government finally closed Yunosawa in 1941.

Objectives The aim of this study was to examine the association between the number of neighborhood facilities that were assessed according to postal code and objectively measured physical activity by using an accelerometer in community-dwelling Japanese people.Methods The participants included 1,274 Japanese people aged 30-84 years from the Saku cohort study. As neighborhood facilities related to physical activity, we extracted information regarding train stations, supermarkets/convenience stores, postal offices/banks, hospitals/clinics, public offices/community centers, cultural facilities/public children's houses, parks, and sports facilities by using each participant's postal code from the online version of the iTownPages directory published by Nippon Telegraph and Telephone Corporation (NTT) and the official homepage of the Saku City Government Office. We measured each participant's physical activity level using an accelerometer, and calculated the average daily step count and the average weekly period of moderate-to-vigorous intensity (≥3 metabolic equivalents of tasks [METs]) physical activity. The association between two selected physical activity-related variables and the numbers of eight types of neighborhood facilities were analyzed by multivariate logistic regression analysis for people aged 30-64 years and for those aged over 65 years.Results On multivariate logistic regression analysis, meeting the 23 METs h/week of moderate-to-vigorous intensity physical activity was significantly and positively associated with the number of supermarkets/convenience stores in the neighborhood in both age groups. In addition, meeting the desired daily step count outlined in the Japanese National Health Promotion guidelines was positively related to the number of postal offices/banks for people aged over 65 years.Conclusion The results of this study suggest that a sufficient number of neighborhood facilities (i.e., stores, banks, and postal offices) is closely associated with the promotion of physical activity.

Objectives This study was conducted to develop a scale for measuring "attachment to the local community" for its use in health services. The scale is also intended to nurture new social relationships in late middle-aged individuals.Methods Thirty items were initially planned to be included in the scale to measure "attachment to the local community", according to a previous study that identified the concept. The study subjects were late middle-aged residents of City B in Prefecture A, located in Tokyo suburbs. From the basic resident register data, 1,000 individuals (local residents in the 50-69 year age group) were selected by a multi-stage random sampling technique, on the basis of their residential area, age, and sex (while maintaining the male to female ratio). An unsigned self-administered questionnaire was distributed to the subjects, and the responses were collected by postal mail. The collected data was analyzed using psychometric study of scale.Results Valid responses were obtained from 583 subjects, and the response rate was 58.3%. In an item analysis, none of the items were rejected. In a subsequent factor analysis, 7 items were eliminated. These items included 2 items with a factor loading of <0.40, 3 items loading on multiple factors and showing a factor loading of ≥0.40, and 2 items with a low factor correlation (0.04-0.16). These items included factors that related to only these 2 items. Consequently, 23 items in the following 4-factor structure were selected as the scale items: "Source of vitality to live life," "Intention to cherish ties with people," "Place where one can be oneself," and "Pride of being a resident." Cronbach's coefficient α for the entire scale of "attachment to the local community" was 0.95, demonstrating internal consistency. We then examined the correlation with an existing scale to measure social support; the results revealed a statistically significant correlation and confirmed criterion-related validity (P<0.001). In addition, the fit indices in a covariance structure analysis showed adequate values.Conclusions The developed scale was considered reliable and appropriate for measuring "attachment to the local community."

Not only physical but also mental health is the wish of every individual, and this is a fundamental human right as a citizen. Rather than the pursuit of economic wealth, the future goal of society should consist of improving each individual's mental "capital" in the different stages of life, which will ultimately lead to an increase in the level of mental wealth in society as a whole. The disability-adjusted life years (DALYs) of psychiatric disorders have outweighed diseases such as cancers and cardiovascular disorders, and the early detection and prevention of psychiatric disorders has become a top-priority issue. We, psychiatrists, are thus professionals markedly responsible for public wealth. Psychiatric disorders and a person with a disorder should be understood from pluralistic perspectives; universality as a brain disorder and, on the other hand, individuality as a person who lives a personal life in pursuit of personal values. Here, I redefine psychiatry as medical science of the brain, mind, and social life, where a balanced model between medical treatment in academia and social support in the community may constitute a new way of working (NWW) for psychiatrists. It is time to launch NWW for young psychiatrists to make a true difference for individuals with psychiatric disorders. To do so, they need to achieve a deeper understanding of developmental processes of establishing self and values, and the significance of living in the community and employment for human beings.

This paper provides a comparative analysis of two communities in Japan based on long-term anthropological fieldwork: one is the community of those with hattatsu shōgai (developmental disorder) and their families and the other is the community of those who have experienced hikikomori and their families. The purpose of this paper is to examine the similarities and differences between the two communities in terms of the ways in which medical diagnoses are understood, identities are formed and certain perspectives on society are shared. By doing so, we attempt to move beyond the clinical sphere to capture the sociocultural significance of "being" an individual with developmental disorder or hikikomori experience.

Objectives: We aimed to develop measures to assess features of neighborhood quality and individual social capital, as well as their associations with depressive symptoms among early adolescents. To determine whether relations of depressive symptoms with neighborhood quality might be contingent upon the level of individual cognitive social capital, neighborhood-by-cognitive social capital interaction terms were examined., Methods: A qualitative study was conducted to elicit the perceptions of early adolescents about their neighborhood environment. Subsequently, we recruited 2,002 eighth graders and asked for responses to a self-administered questionnaire. The variables analyzed in this study were the Center for Epidemiologic Studies-Depression scale (10 items), features of neighborhood quality, cognitive and structural individual social capital, and demographics. We adopted a generalized estimating equation regression model for the multivariate analysis. The analytic sample was 1,786 with no missing variable in the models., Results: Seven subscales were devised to assess quality features of neighborhood environments with an examination of validity and reliability: "availability of services," "good neighborhood relations," "spaces for recreation," "insecurity and danger of accidents," "dirty-looking, squalid, unclean," "civic communities," and "aesthetic look." We also developed a scale of individual cognitive social capital, which consisted of three constructs: "social trust," "reciprocity," and "social norms." Additionally, the number of social activities in which subjects participated was counted as an indicator of the structural aspect of individual social capital. On examination with the generalized estimating equation regression model, "availability of services," "insecurity and danger of accidents," "dirty-looking, squalid, unclean," and cognitive social capital were significantly associated with the CES-D scores controlling for demographics. We also found a significant interplay between "dirty-looking, squalid, unclean" and the cognitive social capital for estimating scores of depressive symptoms., Conclusion: Improvement in features of neighborhood quality such as availability of services, cleanliness, and security and social order in terms of public policy as well as civic activities could contribute to promotion of mental health in adolescents. Individual cognitive social capital accumulated through experiencs of good social relationshisp in a community could also play important roles in maximizing mental health.

Objectives: In order for community-based health promotion and prevention activities to be effective and efficient, it is important to assess the community consciousness among local residents. The purpose of this study was to review the reliability and validity of the Attitude toward Community Scale (ACS) and examine its association with health status among the general population., Methods: A cross-sectional survey was conducted in February 2009 using a mail-in self-administered questionnaire. The target population comprised 4,123 randomly-selected local residents aged 20 years and over living in Kashiwa city, Chiba prefecture, Japan. The questionnaire encompassed the ACS (the wording of some items was modified), an also included data to allow assessment of demographics and health status., Results: Of 4,123 questionnaires, 1,735 could be analyzed (valid response rate: 42.1%). Confirmatory factor analysis supported the two-factor model of the original scale. The reliability of the scale was verified using the Cronbach's alpha coefficient. All item-total correlations were moderately or strongly positive. Logistic regression showed that a better attitude toward the community was associated with higher self-rated health, less anxiety about the future and less loneliness., Conclusion: Although the original scale was developed in 1978, the ACS still appears applicable for modern research following some wording modifications of the items. In future studies, it will be necessary to clearly establish relationships between health status and community consciousness and to develop methodology for enhancing the latter.

Objective: There are several hypotheses for why the prevalence of pollinosis is increasing. The purpose of this study is to assess various factors related to the pollinosis., Methods: The subjects were 10,898 participants aged between 47 and 77 years old who completed a self-administered questionnaire in 2000, in the second survey of a population-based cohort in Gunma Prefecture, named the Komo-Ise Study. The questionnaire included items on health status, history of diseases including pollinosis, occupation, habits, daily activities, and family life. Logistic regression analysis was conducted to determine the odds ratios of various life-style factors in relation to the history of pollinosis. The odds ratios were adjusted for sex, study area, and age., Results: A history of pollinosis was observed in 17.1% of all the subjects. Women were more frequently affected than men [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI): 1.17-1.46]. City residents were more likely to have a history of pollinosis than village residents (aOR = 1.56, 95% CI: 1.36-1.76). Those in their 70s had less history of pollinosis than counterparts in their 40s (aOR= 0.19, 95% CI: 0.15-0.24). There was a statistically significant association between age and remission of pollinosis (P for trend < 0.001). With respect to health, trouble getting to sleep or staying asleep, a history of hyperlipidemia, asthma, ulcer, low back pain, and depression or neurosis were significantly linked with pollinosis, while a history of diabetes had a significant inverse association. With respect to life-style, the following factors were all significantly associated with the history of pollinosis: currently employed person, office worker, emotional stress at work, eating between meals, having meals regularly, eating until completely full, drinking wine or sake less than once a week, drinking beer, drinking spirits, whisky or brandy almost everyday, taking long walks, doing physical exercise, cleaning the house, going out for entertainment, going shopping, having been married, having children with some problems and more than 10 million yen income. There were significant inverse associations between a history of pollinosis and being a farmer, having a current smoking habit, going to pachinko and going to karaoke., Conclusion: Our results suggest that a history of pollinosis is strongly associated with the following host factors: being female, young age, city dwelling, self-rated stress, over-nutrition, office working, and high socio-economic status.

Aim: To clarify the usefulness of the number of steps walked daily as a health promotion parameter in the elderly., Methods: The study was performed at five welfare centers for the elderly in the suburban area of Takatsuki-city, Japan. Subjects comprised 339 community-dwelling persons (96 men and 243 women) aged 60-89 years. The number of steps walked daily, usual walking speed, "timed up and go" (TUG) time, handgrip strength, body muscle mass and bone density were measured. Psychological and physical status and lifestyle factors were determined vie questionnaire. Subjects were classified into one of two groups, a low- or high-level walking group, according to the Healthy Japan 21 criteria. Differences between the two groups were analyzed., Results: Men walked 8,075 steps (mean number) daily, and women walked 7,902 steps daily. The number decreased with age in both men and women and correlated with usual walking speed and TUG time. Low-level walking was found in 41.7% of men and 28.8% of women. Intermittent claudication and fear of falling were the main contributors to low-level walking, whereas walking almost daily and engaging in physical activity with a view toward health promotion were the main contributors to high-level walking., Conclusion: For the elderly population, the number of steps walked daily was related to their walking ability, such as walking speed and walking balance, and could be considered as a useful health promotion parameter. Taking a walk daily could be the main approach to increase the number of steps walked daily in the elderly.

Objective: The aim of this study was to clarify the influence of volunteerism as part of a long-term care prevention program on social and physical health indicators and QOL, as compared with non-participation among elderly people., Methods: The baseline survey was conducted in 2003 among elderly people (age, 70-84 years) living in a rural community in Miyagi Prefecture. We recruited elderly volunteer leaders for long-term care prevention from among the 1,503 elderly people participating in the baseline survey. Of these, 77 individuals were registered as volunteer leaders. One year later, we conducted a follow-up survey to clarify the influence of volunteerism. Finally, we analyzed data for 69 volunteer leaders and 1,207 non-leaders, focusing on influences of volunteerism on social and physical health and QOL using a logistic regression model. State of volunteer activity was treated as a dependent variable, and social and physical health indicators and QOL indices as independent variables., Results: Non-participating individuals had significant declines in Intellectual Activity (OR: 4.51, 95% CI: 1.60-12.74), Social Role (OR: 2.85, 95%CI: 1.11-7.21), Self-efficacy for ADL (OR: 4.58, 95%CI: 1.11-18.88), Satisfaction with Economic State (OR: 2.83, 95%CI: 1.11-7.21), and Contact with Neighbors (OR: 3.62, 95%CI: 1.29-10.16), as compared with volunteers., Conclusion: These results suggest that volunteerism prevents lowering of higher-level functional capacity and social networking among community-dwelling elderly individuals.

Objectives: This study was conducted in order to examine the prevalence of geriatric syndrome (falls, incontinence, depression, and under-nutrition) in community-dwelling elderly people, and to analyze the health status of the elderly with geriatric syndrome risk compared to those of a group not at risk., Methods: The subjects comprised 1,784 residents (769 men and 1,015 women) aged 70 years or more living in Itabashi-ku, Tokyo, who took part in the study. For this study, we divided the subjects into two groups: those with geriatric syndrome (n=688) and those without (n=1,096)., Results: It was found that 33.6% of men and 42.4% of women had geriatric syndrome. Elderly with geriatric syndrome in both men and women had a significantly lower the proportion of subjects who perceived as 'healthy' in terms of the self-rated health, the higher-level functional capacity, higher prevalence of fear of falling, and decreased physical performance including handgrip strength and usual.maximal walking speed than those in the group who did not have geriatric syndrome. Logistic regression analysis showed that geriatric syndrome was associated with poor perceived self-rated health, a lower hemoglobin level and a slower usual walking speed in men, whereas in women it was associated with poor perceived self-rated health and fear of falling., Conclusion: Elderly individuals with geriatric syndrome have significantly decreased health status and physical performance compared to those without geriatric syndrome.

Objective: Well-rounded training, composed of resistance training, aerobic training and flexibility exercise, has been shown to be beneficial for increasing the physical strength of the elderly. The purpose of this study was to investigate the effects of a trial of community-based well-rounded training on women inhabitants to strengthen leg muscles., Methods: The subjects were the women aged 65 to 74 years living in E city, Gifu prefecture in Japan, who gave informed consent for participation in a community-based well-rounded training class in 2003 or 2004 (n = 24), while others taking part in a recreation class for the aged served as the controls (n = 15). The training class was performed once a week for 12 weeks, while the recreation class was conducted every two weeks for 12 weeks. Self-reported questionnaire surveys of health status and examinations of physical characteristics and physical fitness were conducted before the beginning of each class and after the end of the 12-week class., Results: In the training class, the replies to the following items of questionnaires were significantly improved: "Are you confident in your present physical strength? (P < 0.01)", "How long can you walk at your ease? (P < 0.05)" and "How many times do you go out usually? (P<0.05)." On the other hand, there were no significant changes in the recreation class. Regarding physical fitness, both subjects and controls had significant improvements in a 10 meter-walking test, a body reaction time test and a 30-sec chair-stand test. In addition, training class attendees showed an increase in forward bending ability, an index of flexibility (P < 0.01), and the cross-sectional area of femoral region muscles measured by computer tomography (P < 0.05)., Conclusion: The present trial in a community suggested that well-rounded training has some beneficial effects to increase or maintain the physical strength of the leg muscles and the flexibility of bending among inhabitants aged 65-74. Community-based well-rounded training programs for the aged will assume greater importance with the rapid increase in aging populations.

Objective: The present study was performed to comprehensively investigate the prevalence of multiple symptoms of the geriatric syndrome, characteristics and related factors in urban community-dwelling elderly women., Methods: Among 669 women aged 70 years and above living in 5 areas of Itabashi-ku, who attended the Otassha Kenshin (comprehensive health check for the elderly) in November 2004 and gave consent to participate in this study, 668 had no missing data and their interview and physical fitness data were analyzed. The criteria for the geriatric syndrome were: (1) functional decline: a score of 10 points or below for the 13 items of the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence; (2) falls: "have fallen" once or more in the last year; and (3) urinary incontinence: frequency of urine leakage of "1 to 3 times in a month" in daily life. The interview and physical fitness data were compared between healthy persons, persons with one symptom and persons with multiple symptoms. Multiple logistic regression models were used to analyse related factors., Results: The prevalence of multiple geriatric syndromes was 15.3%; comprising 2.2% with "functional decline+falls", 6.0% with "functional decline+urinary incontinence", 5.1% with "falls+urinary incontinence", and 2.0% with "functional decline+falls+urinary incontinence". The group reporting multiple symptoms had poor self-rated health, had a high percentage currently taking three or more medications, had a fear of falling and had a significantly (P < 0.05) higher likelihood of a history of stroke and urinary disease. In addition, the group with multiple symptoms were older, and had significantly (P < 0.05) poorer results for grip strength, usual walking speed, maximum walking speed, functional reach, knee extension strength, and one leg standing time with eyes open. Within this group, the "functional decline+falls" subgroup had the lowest level of physical fitness. Analysis of factors related to the presence (1) or absence (0) of multiple symptoms identified fear of falling and usual walking speed as two significant variables., Conclusion: This study showed that: (1) physical fitness is significantly lower in the group with multiple symptoms of the geriatric syndrome compared with healthy persons, and was the lowest in the subgroup with "functional decline+falls"; and (2) fear of falling and usual walking speed were two factors related to multiple geriatric syndromes. These results suggest directions for future intervention strategies.

Aim: It is necessary to determine the effect of exercise on each individual in order to target a person for an exercise regimen intended to prevent specific health defects in the elderly. The purpose of this study was to evaluate the relationship between physical conditions and changes in functional measurements after exercise intervention., Methods: Two hundred seventy-six subjects aged 60 years and older practiced exercise intervention for three months. The measurements were maximal walking speed, one-leg standing with eyes opened or closed, functional reach test, timed up and go test, sit and reach, handgrip strength, and knee extensor strength. We evaluated the associations between physical measurements and changes in functional measurements., Results: Except for one-leg standing with eyes closed, all measurements of physical function were significantly improved after exercise intervention. The changes in functional measurements showed significant negative correlations with the initial physical performance measurements, except for maximal walking velocity., Conclusions: These results provided valuable information on more effective strategies for improving or maintaining physical functions of community-dwelling older people. Comprehensive approaches that adapt the methods of training to the fitness level of each subject are needed to effectively improve the physical function of older people.

Purpose: This study was conducted to examine the relationship between physical activity level (PAL) and physical, mental and social factors in community-dwelling elderly people., Methods: The subjects comprised 428 residents aged 70 or over living in Kusatsu-machi, Gunma, who took part in an interview and tests of physical fitness as part of the "NIKKORI-KENKOSODANJIGYO". Data for 330 out of the 428 residents were adopted for this study. The PAL was evaluated with a questionnaire developed by Naito et al. (2003). Subjects were interviewed on physical, mental and social functioning including the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence and cognitive function (Mini Mental State Examination: MMSE). Physical fitness tests included assessment of handgrip strength, usual and maximal walking speed, and one-leg standing balance with eyes open., Results: Correlations between PAL and the TMIG Index of Competence, physical (e.g. physical fitness), mental (e.g. depression) and social (e.g. roles at home) factors, and smoking status were significant by ANCOVA adjusted for age and sex. Analysis using a general linear model indicated that smoking status, usual walking speed, depression, roles at home, frequency of going outdoors and visual impairment all together explained 13.5% of the PAL variance., Conclusion: The findings indicate that PAL in the community-dwelling elderly aged 70 years or over is associated with physical, mental and social factors.

Objective: Schizophrenic patients' quality of life (QOL) has become increasingly important due to shift of mental health care from hospitals to communities. This paper describes a longitudinal study conducted to clarify relationships among the QOL, self-esteem, depressive mood, and uncooperativeness of schizophrenic patients identified in the authors' previous crosssectional study., Methods: Subjects were 61 schizophrenic patients attending day care at mental hospitals. They were assessed initially, and again after a 12-month follow-up. The assessment was carried out using the Rosenberg Self-Esteem Scale, WHOQOL-26 Scale, and the Brief Psychiatric Rating Scale, and included personal characteristics. Covariance structure analysis (Synchronous Effects Model) was conducted to clarify the relationships between self-esteem and the WHOQOL-26 Scale, and between psychiatric states (depressive mood and uncooperativeness) and self-esteem, while controlling for subjects' individual characteristics and use of antipsychotics as confounding factors., Results: The results indicated that self-esteem had a significantly positive effect on the WHOQOL-26 Scale while depressive mood and uncooperativeness were without significant effects., Conclusions: The results provide evidence that the enhancement and maintenance of self-esteem may be an effective method of improving WHOQOL-26 in schizophrenic patients.

Objectives: A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people., Methods: A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls., Results: A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants., Conclusions: This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.

Objective: To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community., Methods: Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification., Results: Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females., Conclusions: Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.

The "Reform Vision of Mental Health Services" (2004) announced the basic policy for the transition from hospital based to community based care, and set up numerical objectives, such as the average proportion remaining hospitalized in the first year after admission and the incidence rate of discharge among psychiatric patients hospitalized for more than one year. Using data from the "Patient Survey" performed in 2002 by the Ministry of Health, Labour and Welfare, we estimated discharge curves for each mental disorder during the first year after admission and assessed the effects of variables, i.e., diagnosis, sex, age, hospital type, and residential area, on remaining hospitalized after one year from admission and the incidence rate of discharge among psychiatric patients hospitalized for more than one year. The estimated number of discharged psychiatric patients was 27,974 in September, 2002, and 86% of them were discharged less than one year after admission. The incidence rate of discharge (per 100 person-year) in the first year was 314.8, but the rate after the second year sharply decreased to 19.9. Patients with dementia, mental retardation, and schizophrenia tended to stay for a long period in hospital, and proportions remaining hospitalized after one year from admission were 27.0%, 16.4%, and 14.6% respectively. Based on multivariate analysis using the weighted Poisson regression model, risk factors associated with an increased chance of remaining hospitalized after the first year included a long length of continuous hospitalization, diagnoses of dementia, mental retardation, and schizophrenia, male, older age, and being in a mental hospital. On the other hand, as to the incidence rate of discharge after one year, a long length of continuous hospitalization and being in a mental hospital were related with a long stay, but other variables were slightly different. Being female, patients aged 45-54 years old, and diagnoses of epilepsy and schizophrenia were associated with a long stay. These results clarify the present situation of discharge among psychiatric inpatients and indicate the important variables associated with discharge to prevent new long hospital-stay cases in Japan.

In Mizumaki-cho, Fukuoka, a "School of muscle-building for the elderly" was held by the self-help group "MIZUMAKI Iki-iki senior club" once a week from Sep. 2002 to Mar. 2004. This school program included stretching, aerobics and resistance exercises. In this study, we clarified the effect of exercise for the 38 elderly females in this school. Their average age was 65.8 years old. Blood pressure, BMI, body %Fat, VO2 max, grasping power, time of standing on one leg with eyes open, anteflexion while sitting, time of walking for 10 m and time of standing up from sitting on a chair were measured before starting school, after 6 months, 12 months and 18 months. Every measured value except BMI and VO2 max was improved, and these improvements continued for 18 months. Especially, it was shown that time of standing on one leg with eyes open, time of standing up from sitting on a chair and time of walking for 10 m improved by 121.6%, 112.7%, 30.4%, respectively, compared with each measured value at the start. These improvements might produce the effect of fall prevention for the elderly. From the results of this study, it was clarified that regular exercise builds up the muscles of the female elderly, and continuation of exercise also extends the effect of exercise for the female elderly.

Purpose: Functional decrease in brain activity as a factor inducing dementia is due not only to aging but also to decrease in social exchange, loss of something to live for, and decrease in physical activity with indoor confinement. It might therefore be possible to use these parameters to screen for risk of dementia in community care programs. In the present study we evaluated the association between decreased daily-social activity and symptoms of forgetfulness., Methods: The subjects were 6,486 people aged > or = 65 years living in 3 municipalities in Yamanashi Prefecture. A survey table concerning daily-social activity and symptoms of forgetfulness was produced, and a whole-sample survey was performed by mail. Cluster analysis of items such as symptoms of forgetfulness was performed, and clusters were obtained. Associations between these clusters and daily-social activity were then analyzed by the Mann-Whitney test., Results: Of 5,556 replies (recovery rate, 85.7%), 3,067 with all items filled out (effective reply rate, 55.2%) were analyzed. None of the 21 items for forgetfulness was applicable in 600 of the subjects (19.6%). Cluster analysis of the other 2,467 subjects with 1 or more symptoms revealed the following 5 clusters: "common forgetfulness symptoms" consisting of 2 items, "decreased will to live" consisting of 8 items, "amnesic symptoms" consisting of 4 items, "emotional responses" consisting of 2 items, and "difficulty in daily life" consisting of 5 items. There were 31 types of cluster combinations in the subjects, and the most frequently applicable cluster was "common forgetfulness symptoms" (658 subjects, 21.5%). Comparison of the daily-social activity between the cluster groups showed significant differences in many of the items for daily-social activity with reference to the "decreased will to live"., Conclusion: Among forgetfulness symptoms, items classified as related to "decreased will to live" were most associated with daily-social activity. This suggests utility for evaluation of daily-social activity, including intellectual and social activity frequency in elderly people in communities to select people for care programs for prevention of secondary dementia.

Objective: To identify associations between social relationship factors and risk of requirement for care in elderly people living at home., Method: In February 2000, a questionnaire was distributed to all residents aged 65 and over in a city in Aichi prefecture, Japan. The number of responses was 3596, a return rate of 72.0%. The records of 2725 subjects who were not under care as of April 2000 were selected as a sample and treated with Cox's proportional hazards model in order to analyze associations between social relationship variables and the risk of care requirement., Results: (1) For males, the higher the acceptance of support, the higher the risk of care requirement (hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.21). For females, the lower the contact frequency with separately-living family members, the higher the incidence (HR2.14, 95% CI 1.27-3.62). Also, the analysis of female subjects showed a strong association between not providing social support to others and the risk of care requirement (HR2.75, 95% CI 1.61-4.71). (2) Analysis of the effects of social support indicated that the male subjects who did not provide support to others but received such support themselves were at significantly high risk of care requirement (HR2.90, 95% CI 1.17-7.18). (3) In the case of female subjects who lived alone, unlike those with other living arrangements, there appeared to be no significant associations between involvement in social networks and their support provision to others, and the risk of care requirement., Conclusions: The study confirmed that gender and living arrangements both influence associations between the risk of care requirement in the elderly and social networks and support. The study also indicated that provision of support by the elderly is one important factor that can lower the risk of needing care.

Objective: The purpose of this study was to assess relationships between life satisfaction and lifestyle in residents of the city of Kyoto, Japan, by addressing their subjective evaluation of their own health status., Methods: The subjects comprised 4746 men and women (15-97 years old) who had completed a questionnaire on life style in the 1998 Kyoto Citizen's Health and Nutrition Study. Stratified by their responses to subjective health, the relationship between life-satisfaction and lifestyle was evaluated by odds ratios and chi-square tests of the subjects classified by age and gender., Results: The proportion of respondents who felt their subjective health was good decreased with age, while the proportion of respondents who considered their life satisfaction good increased with age. Whether the residents had good or poor subjective health, the proportion of respondents who had a healthy lifestyle, as exemplified by having breakfast everyday, having dinner with their family regularly and having a good intake of greeny-ellow vegetables increased with age in both men and women. This healthy lifestyle was also positively associated with good life satisfaction., Conclusion: Whether the residents had good or poor subjective health, these results suggest that thos with a healthy lifestyle feel good life satisfaction.

Purpose: Previous studies have indicated that memory complaints may predict cognitive decline and dementia among the elderly. The present study was therefore conducted to clarify memory complaint characteristics among elderly dwelling in an urban community in Japan., Method: The participants analyzed in the present study were 453 men and 385 women aged 70 to 84 years living in an urban Japanese community. Data on problems related to memory complaints, cognitive decline (below 24 points on Mini-Mental State Examination), depression (measured by Mini-International Neuropsychiatric Interview), hearing and vision problems, I-ADL (measured by TMIG Index of Competence), self-rated health, age, sex, and years of education were collected at a comprehensive mass health examination for the elderly ("Otasha-kenshin")., Results and Discussion: Twenty-seven percent of male respondents and 32% of female respondents reported having current trouble remembering things (reported as "frequently" or "sometimes"). We collected specific descriptions of the memory complaint difficulties the subjects were experiencing. A quarter of the responses indicated problems with forgetting persons' names, a fifth with forgetting where things had been left, 15% with leaving things behind, and a quarter with prospective memory failure. The results of multivariate logistic regression analysis to explore correlates showed that in men self-rated health and cognitive decline, and in women hearing problems and self-rated health were significantly and independently related to the memory complaint. These findings suggest that in addition to cognitive decline, self-rated health and hearing problems may influence memory complaints, and that memory complaints in men may be a reliable, simple indicator of cognitive decline. We now need to carry out a longitudinal study to clarify predictive validity.

Background: Many studies have documented that social participation is beneficial for maintaining autonomy and quality of later life. However, little is known about present state of social participation in the Japanese elderly and effective means for its promotion., Purpose: To establish what factor might promote social participation in later life, this study was performed to examine the present state of social participation and a number of parameters among middle-aged and older people living in a Japanese community., Methods: The subjects comprised 1,568 residents aged 55 to 79 years, a 1/3 random sample selected from the total population of this age group in H town, Saitama Prefecture. They were requested to answer the questionnaire delivered by mail. We examined the level of social participation from four aspects: work, social and volunteer activities, individual pursuits and study activities, and analyzed possible associations with demographic, socio-economic, health-, and community-related variables by multiple regression analysis., Results: A total of 964 persons answered the questionnaire (61.5% response rate). Age and gender were associated with each of four social activity domains. Living arrangements (with or without spouse) were independently associated with social and volunteer activity, and study. Educational attainment positively correlated with work and individual pursuits. Residents in a newly constructed town-region were less likely to engage in work, social and volunteer activities, and study than their counterparts living in an older town-region. Those who had a stronger sense of co-living in the community, and who would like to keep their social activity level, were more likely to participate in social and volunteer, as well as study activities and also individual pursuits. People feeling that the municipality should support social activities among residents had a higher level of study activity., Conclusions: These results show that cultivating a sense of co-living in the community among residents and maintaining their motivation are needed for promoting social participation among older residents. To what extent public support should meet potential needs of social participation remains for further study.

Although in 1969, rice pollen was first reported as a cause of asthma, rice pollen allergy has not been studied after the first report and thus the allergic significance of rice pollen is not well recognized at present. We investigated the sensitization to various allergens and the residential areas in children with the symptoms of asthma or rhinoconjunctivitis during the first decade of August, and measured rice pollen-specific IgE antibodies. Eighty-eight children (57 boys and 31 girls, mean age 8.5+/-2.9 years) with bronchial asthma or allergic rhinitis/conjunctivitis were included in this study and divided into two groups: children with (n=21) or without (n=67) symptoms during this period. The positivity rate to orchard grass pollen and the rate of residence in the surrounding area of rice field were high (81%, P=0.008 and 86%, P<0.001, respectively) in children with allergic symptoms, as compared to the values (48% and 27%, respectively) in children without symptoms. As the rice pollen season in Nagano occurs in the first decade of August, we measured rice pollen-specific IgE antibodies in 8 patients with symptoms during this period; all of these patients showed positive IgE antibodies to rice pollen. The RAST-inhibition assay using orchard grass and rice pollen indicated cross-allergenecity between these two pollen and also the existence of rice pollen-specific allergens. These results suggest that rice pollen induces seasonal asthma and allergic rhinoconjunctivitis during the first decade of August, which is the rice pollen season, in the surrounding area of rice fields.

We conducted a comprehensive evaluation of the mental health of community-dwelling elderly people, and encompassed the physiological, psychological, social and environmental aspects of their lives. The study used a questionnaire similar to the one used by Matsubayashi et al in their study in Kahoku-cho. The Japanese version of General Health Questionnaire 12 (GHQ-12) was used to evaluate mental health. Responses were received from 2,799 (81.5%) of 3,432 Numura-cho residents. After eliminating inadequate responses, 1,298 (37.8%) (586 men and 712 women) were analyzed. By setting mental health disorder, defined as a value of GHQ-12 exceeding 4.0, as the target variable, logistic regression analysis was conducted using the background factors as explanatory variables. Information related function (odds ratio: 0.45; 95% CI: 0.30-0.66), living with others (0.36, 0.14-0.94), presence of spouse (2.52, 1.14-5.59), economic condition (0.45, 0.22-0.91), family relationship (0.17, 0.05-0.52), work & sports (0.31, 0.14-0.67) and emotional support (0.67, 0.48-0.95) were found to be explanatory variables for mental health in the young elderly; as were activities of daily living (0.52, 0.35-0.79), Information related function (0.56, 0.35-0.90) and emotional support (0.37, 0.24-0.58) in the old elderly; as were activities of daily living (0.37, 0.19-0.70) and economic condition (0.32, 0.11-0.95) in the very old. For amelioration of the mental health of elderly persons living in the community, attempts should be made to improve the background factors clarified by the present study by efficiently utilizing health, medical and welfare services.

Purpose: The purpose of this study was to clarify environmental conditions determining the social activities of the elderly, by analyzing levels of activity in individuals belonging to clubs for senior citizens., Methods: In 1998, we conducted a survey of over 10,000 elderly subjects, 65 years of age or older, who belonged to 228 clubs for senior citizens in a region of Saitama Prefecture, using a 'Check list' developed for self-evaluation of social activities. The proportions of 'active' and 'inactive' seniors, as judged by the 'Check list' for each of the four different aspects of social activities (1. individual activities, 2. social participation/volunteering, 3. education/training, 4. employment), were compared with those of the standard elderly population., Results: Two hundred and seven clubs for senior citizens (90.8%) participated in this study. About 82.0% of the members of each club filled out the 'Check list'. High levels as compared to the standard population were demonstrated for two aspects of social activity: individual activity and social participation/volunteering. Women had higher levels of both types of social activity than men. Men aged 74 years or younger had lower than average levels for three aspects of social activity: social participation/volunteering, education/training, and employment. Members who resided in urban areas with easy access had higher levels of individual activity, social participation/volunteering and education/training. On the other hand, those residing in suburbs with large spaces for agriculture had higher levels for employment., Conclusion: Our results for social activities of elderly subjects belonging to clubs for senior citizens indicate that strong correlations exist with environmental conditions, including communication facilities and local or industrial structure.