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Introduction: COVID-19 caused major disruptions across the super-aged nation of Japan, yet few studies explored temporal changes among middle-aged and older cohorts from baseline to the height of community transmission. Changes in physical activity and sedentary behavior during global pandemics may alter patterns of morbidity and mortality among susceptible aging populations. Objectives: This study investigated patterns of physical activity, sitting behavior, and health among representative samples of middle-aged and older adults in Tokyo before and during the pandemic. Methods: Repeated online surveys were conducted with quota samples of 800 Tokyo residents in 2019 and 2021 using validated Japanese-language measures, including the short form-International Physical Activity Questionnaire and the Basic Ecological Health Scale-6. Statistical analyses included comparative evaluations of activity parameters by age cohort, gender, and selected covariates. Statistical tests included the Kruskal–Wallis test, Mann–Whitney U test, chi-square test for Independence and Hierarchical Regression. Results: Over 34% of respondents were inactive at each data collection point, and 72% reported negative impacts of COVID-19 on their physical activities. Older adults showed no significant changes in their activity and sitting behavior and reported better health compared with those in middle age across the pandemic. Middle-aged males reported a significant decline in total activity of 33% across the pandemic period (U = 16,958, z = −2.64, p =.008, r =.13). Middle-aged females reported the lowest levels of physical activity, and health, and showed a 29% increase in sitting behavior across the pandemic (U = 16,925, z = −2.68, p =.007, r =.13). Subjective health status was consistently associated with higher overall activity and walking before and during the pandemic. Conclusion: Differential outcomes were identified between age and gender regarding health, physical activity, walking, and sitting across the pandemic with significantly worse impacts reported among middle-aged samples. Implications: These results have implications for healthy transitions to later life and the design of postpandemic interventions to address activity opportunities in Japan. [ABSTRACT FROM AUTHOR]

Japan has become a super-aged society. To overcome the negative implications of this, practitioners are increasingly using exercise-based interventions to reduce the requirement for long-term care among Japanese older adults. However, no comprehensive means of assessing the wide range of exercise behavioral determinants exists for this population. Thus, the principle aim of this study was to develop a questionnaire based upon the theoretical domains framework—a framework that has synthesized a wide range of behavior change theories. Completed responses were received from 1,000 Japanese older adults who resided in the Kansai area of Japan. Findings were suggestive of good reliability and validity for seven unique psychological determinants of exercise. This study was the first to provide a measurement tool related to a distinct range of psychological determinants of exercise among Japanese older adults. [ABSTRACT FROM AUTHOR]

Objectives: Despite the recognized impact of intrinsic capacity (IC) impairment on healthy aging, international comparisons in different sociocultural contexts are scarce. This study aimed to compare IC impairment among community-dwelling older adults in Japan and Taiwan to explore the context of healthy aging in different countries. Design: Comparative observational study. Setting: National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan and Longitudinal Aging Study of Taipei (LAST) in Taiwan. Participants: 794 individuals (age range, 60.0–86.5 years) from NILS-LSA and 1,358 (60.0–96.7 years) from LAST. Measurements: IC impairment was evaluated across the domains of locomotion, cognition, vitality, sensory capacity, and psychological well-being. Participants were categorized as having impaired IC or healthy. We investigated associations between IC impairment, falls, and all-cause mortality. Results: IC impairment was present in 54.9% and 37.3% of participants in the NILS-LSA and LAST cohorts, respectively. Male NILS-LSA participants with impaired IC (odds ratio [OR]:1.50, 95% confidence interval [CI]:1.03–2.20), with hearing loss (OR:1.98, 95% CI:1.00–3.90) were more likely to fall. In LAST, impaired locomotion (OR:2.14, 95% CI:1.46–3.14) increased the risk of falls. Men with impaired IC (hazard ratio [HR]; 2.14, 95% CI.10–4.15) and visual impairment (HR:2.21, 95% CI:1.15–4.25) and women with impaired psychological well-being (HR:4.94, 95% CI:1.28–18.97) in the NILS-LSA cohort had greater risk for all-cause mortality; however, this was not shown for LAST participants. Conclusion: The prevalence and distribution of IC impairment and associated biomarkers differed significantly between participants in Japan and Taiwan. However, the associations with adverse outcomes remained similar, emphasizing the need for tailored interventions for healthy aging. [ABSTRACT FROM AUTHOR]

This study examined whether satisfaction with social interactions and the number of people interacted with during walking groups is associated with affective responses among older adults. Twenty-six older adults were asked to participate in five walking group sessions. The participants walked together for 40–50 min. In every session, the participants reported their affective responses to walking (positive engagement, tranquility, and negative affect), their level of satisfaction with the social interactions experienced, and the number of people interacted with during the walk. The available data were from 107 person-sessions. Multilevel models revealed that, although a higher number of people interacted with was not significantly associated with improvements in any affective responses, higher satisfaction with the interactions was significantly associated with improvements in positive engagement at both the within- and between-person levels. This study found that higher satisfaction with the interactions was associated with desirable affective responses among older adults. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have shown that musical instrument training programs of 16 or more weeks improve verbal memory (Logical Memory Test delayed recall), processing speed (Digit Symbol Coding Test), and executive function (Trail Making Test Part B) of musically untrained healthy older adults. However, it is unclear whether shorter-period instrument training can yield similar effects. We sought to (1) verify those results and (2) clarify if intervention effects could be detected using other measures such as reaction time. Methods: Healthy older adults (mean age = 73.28 years) were pseudo-randomly assigned to an untrained control group (n = 30) or an intervention group (n = 30) that received a weekly 10-session musical instrument training program (using melodica). We conducted neuropsychological tests on which intervention effects or association with musical training were reported in previous studies. We newly included two reaction time tasks to assess verbal working memory (Sternberg task) and rhythm entrainment (timing task). Intervention effects were determined using a "group x time" analysis of variance (ANOVA). Results: The intervention effects were detected on the reaction time in Sternberg task and phonological verbal fluency. Although intervention effects had been reported on Logical Memory test, Digit Symbol Coding Test and Trail Making Test in previous studies with longer training periods, the present study did not show such effects. Instead, the test-retest practice effect, indicated by significant improvement in the control group, was significant on these tests. Discussion: The present results indicated the usefulness of working memory assessments (Verbal Fluency Test and Sternberg task) in detecting the effects of short-term melodica training in healthy older adults. The practice effect detected on those three tasks may be due to the shorter interval between preand post-intervention assessments and may have obscured intervention effects. Additionally, the findings suggested the requirement for an extended interval between pre- and post-tests to capture rigorous intervention effects, although this should be justified by a manipulation of training period. [ABSTRACT FROM AUTHOR]

Background: We developed a program that encourages interaction among older people living at home by combining face‐to‐face and online activities and examined its effects on older adults' psychosocial health. Methods: In this mixed‐methods study, we recruited 11 women and 6 men (Mage = 79.5 ± 6.4 years), who lived in a rural community and participated in a senior citizen club. The intervention was conducted for 13 months, comprising monthly face‐to‐face group and social media activities. For the program process evaluation, we collected focus‐group interview data on participants' perceptions of their personal lives, club membership, and community post‐intervention. For the outcome evaluation, we collected six outcome measures pre‐ and post‐intervention: loneliness, subjective health, subjective well‐being, self‐esteem, social support and social activity satisfaction. Finally, through the integration of the process‐outcome evaluation, we inferred what effects the program had on participants' psychosocial health. Results: In the process evaluation, we identified four themes: 'Stimulation brought about by relationships with peers,' 'Realization as to where they feel they belong,' 'Rethinking of oneself in the community,' and 'Awareness of attachment to and coexistence with the community.' In the outcome evaluation, the outcome measures were maintained without significant decline post‐intervention. Conclusion: Through the integration of the process‐outcome evaluation, we deduced three effects of the program on psychosocial health: (1) fulfilment of subjective health, (2) maintenance and assurance of moderate distance connectedness and (3) orientation toward aging in place. Implications for practice: This study offers a promising opportunity for further development and research into community‐based preventive nursing care intervention strategies to maintain the psychosocial health of homebound older people in communities with social activity groups. [ABSTRACT FROM AUTHOR]

This study explored expectations regarding aging among a diverse cohort of undergraduates in Japan. A concurrent mixed methods design was employed with online administration of the Expectations Regarding Aging scale (ERA-12), and open-format and demographic questions among 133 culturally diverse undergraduates in Tokyo. Independent samples t-tests, one-way analysis of variance (ANOVA), descriptive statistics, and thematic analysis were used to explore the data. ERA-12 scores and physical and cognitive function subscale results revealed negative perceptions about the aging process, while scores on the mental health subscale were significantly higher and positive. No significant differences emerged based on gender or cultural background. Qualitative data analysis revealed student awareness of lifestyle influences on health in later life, concerns about current health and risk factors, and potential to transcend negative physical changes by finding meaning in other aspects of life. Understanding expectations regarding aging among younger cohorts may inform gerontological education and public health promotion to support a life course approach to healthy aging. [ABSTRACT FROM AUTHOR]

Rich social capital is regarded as an individual's social asset, which may contribute to the maintenance of functional ability, even in a state of frailty. This study examined the moderating role of individual social capital in the association between physical frailty and functional ability among older adults. A cross-sectional study. In total, 522 community-dwelling older adults aged ≥60 years were recruited from among visitors to public facilities, including community cultural centers and gymnasiums in Aichi, Japan. Functional ability was assessed using the 5-item subscale of the Tokyo Metropolitan Institute of Gerontology Index of Competence that assesses instrumental self-maintenance, including transportation, finance management, and shopping. Physical frailty was defined by the Fried Frailty Phenotype Questionnaire, including 5 items of fatigue, resistance, ambulation, inactivity, and weight loss, and the participants were classified into 3 groups: non-frailty, pre-frailty, and frailty. Individual social capital was assessed for 2 dimensions: the cognitive dimension (perceptions of community social cohesion) and the structural dimension (informal socializing and social participation). The participants' mean age (SD) was 74.1 (6.5) years and 78.0% were women. Among the participants, non-frailty was 46.6%, pre-frailty was 47.0%, and frailty was 6.5%. Multivariable linear regression analysis revealed that physical frailty was associated with lower levels of functional ability compared with non-frailty [pre-frailty: β (95% CI) = −0.07 (−0.22 to 0.08), P =.374; frailty: β = −0.67 (−0.99 to −0.35), P <.001]. However, individual structural social capital showed a negative interaction with physical frailty against low functional ability, indicating a moderating association (P =.027). High levels of individual structural social capital mitigated the adverse association between physical frailty and functional ability. Fostering rich social capital may preserve the functional ability of frail older adults, helping their independent lives in the community. [ABSTRACT FROM AUTHOR]

Background: Among all physical activities, walking is one of the easiest and most economical activities for older adults' mental and physical health. Although promoting social participation may extend the walking time of older adults, the longitudinal relationship is not well understood. Thus, this study elucidates the relationship between nine types of social participation and change in walking time during a 3-year follow-up of older adults.Methods: We conducted a 3-year community-based longitudinal study of independent older adults in Japan. From the 2016 and 2019 surveys, we extracted 57,042 individuals. We performed multiple regression analyses, estimating associations between change in walking time after three years and nine types of social participation in 2016: volunteer, sports, hobby, senior, neighborhood, learning, health, skills, and paid work. We conducted subgroup analysis stratified by walking time in 2016 (i.e., < 60 or ≥ 60 min/day).Results: The mean (standard deviation) change in walking time for 3 years was - 4.04 (29.4) min/day. After adjusting potential confounders, the significant predictors of increasing or maintaining walking time (min/day) were participation in paid work (+ 3.02) in the < 60 min/day subgroup; and volunteer (+ 2.15), sports (+ 2.89), hobby (+ 1.71), senior (+ 1.27), neighborhood (+ 1.70), learning (+ 1.65), health (+ 1.74), and skills (+ 1.95) in the ≥ 60 min/day subgroup compared with non-participants.Conclusions: Paid work and community activities may be effective for maintaining or increasing walking time among older adults with less (< 60 min/day) and sufficient (≥ 60 min/day) walking time, respectively. [ABSTRACT FROM AUTHOR]

Aim: Maintaining ≥20 teeth is a public health goal worldwide. Healthy aging, which includes psychological and social well‐being, as well as physical indicators, has attracted a great deal of attention with the progression of aging societies. However, no studies have examined the association between the number of remaining teeth and healthy aging. This study aimed to investigate the association between the number of remaining teeth and healthy aging. Methods: This community‐based longitudinal cohort study included 8300 Japanese people aged ≥65 years who were free of disability and depression in the baseline survey in 2006. The participants were categorized into four groups according to the number of remaining teeth at baseline: 0–9, 10–19, 20–24 and ≥25. The primary outcome was healthy aging (defined as meeting all four of the following criteria: free of disability, free of depression, high health‐related quality of life and high life satisfaction), as assessed by a questionnaire survey carried out in 2017. Multiple logistic regression was used to calculate the corresponding odds ratios and 95% confidence intervals. Results: During about 11 years of follow‐up, 621 (7.5%) participants attained healthy aging. Participants with ≥20 remaining teeth showed a higher healthy aging rate. Compared with participants with 0–9 teeth, the multivariate‐adjusted odds ratios (95% confidence intervals) for 10–19, 20–24 and ≥25 teeth were 0.98 (0.77–1.26), 1.28 (1.01–1.63) and 1.59 (1.24–2.03), respectively. Conclusions: These findings suggest that maintaining ≥20 teeth was associated with healthy aging. Geriatr Gerontol Int 2022; 22: 68–74. [ABSTRACT FROM AUTHOR]

Background: Our study examined the association between social participation and healthy aging using a community-based cohort study among Japanese older adults.Methods: This prospective study was conducted in Ohsaki City, Japan, and included 7226 participants aged ≥65 years at the baseline survey in 2006. We obtained information on frequency of participation in 3 types of community activities (ie, neighborhood activities, hobbies, and volunteer activities) at baseline. Exposure was measured by the number of types of community activities participated in and participants were categorized into 4 groups (ie, none, 1 type, 2 types, and 3 types). The primary outcome was healthy aging as assessed by a questionnaire survey conducted in 2017, and was defined as meeting the following 4 criteria: free of disability, free of depression, high health-related quality of life, and high life satisfaction. We used multiple logistic regression models to calculate the corresponding odds ratios and 95% confidence intervals.Results: During 11 years of follow-up, 574 (7.9%) participants attained healthy aging. Compared with participants not participating in any activity, the multivariable-adjusted odds ratios (95% confidence intervals) were 1.90 (1.40, 2.59) for those participating in 1 type, 2.49 (1.84, 3.38) for 2 types, and 3.06 (2.30, 4.07) for 3 types (p for trend < .0001). Furthermore, for each type of community activity, a higher frequency of participation was related to higher probability of healthy aging.Conclusions: Our study suggests that social participation is associated with the promotion of healthy aging, and that the benefits were observed across different types of community activities. [ABSTRACT FROM AUTHOR]

Few studies have reported an association between diversity in productive activities and life satisfaction; hence, this cross-sectional study conducted in Japan aimed to clarify this association. We assessed the life satisfaction of 4,498 Japanese community-dwelling older adults engaged in productive activities (e.g., paid work, volunteering, taking care of children, and supporting others) using the Life Satisfaction Scale. We took the sum of the number of engaging productive activities as the diversity in productive activities score. A dose-response relationship was observed for each additional productive activity on life satisfaction. Participants who engaged in one, two, three, or four productive activities were more likely to have higher life satisfaction than those who did not engage; the odds ratios (95 % confidence intervals) were 1.19 (1.02-1.39), 1.19 (1.00-1.42), 1.71 (1.37-2.13), and 2.27 (1.58-3.27), respectively. Diversity in productive activities may enhance higher life satisfaction likelihood among Japanese community-dwelling older adults., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives Heterogeneity in successful aging has been found across countries. Yet, comparable evidence is sparse except in North America and Europe. Extending prior research, this study examined the prevalence and correlates of successful aging in East Asia: China, Korea, and Japan. Method We used harmonized data sets from national surveys. A total of 6,479 participants (aged between 65 and 75) were analyzed. Using Rowe and Kahn's (1987 , 1997) model, successful aging was defined as having no major diseases, no difficulty performing activities of daily living, obtaining a median or higher score on tests of cognitive function, and being actively engaged. Results The average prevalence of successful agers was 17.6%. There were variations in the global and specific measures of successful aging within and across countries, even after controlling for individual sociodemographic factors (age, gender, and education). The odds of aging successfully were highest in Japan and lowest in China, especially in the rural areas. Being younger and males were associated with a higher likelihood of successful agers in both global and specific measures. Discussion This study observed heterogeneity in successful aging in East Asia. To identify policy implications, future research should explore potential societal factors influencing individuals' opportunities for successful aging. [ABSTRACT FROM AUTHOR]

Background: While being obese in mid-life is associated with an increased risk of dementia and cognitive decline in late-life, being obese in late-life is shown to be associated with a lower risk of these outcomes in some studies. This phenomenon is known as the "obesity paradox", but the underlying reasons and potential sex difference have not been well understood.Objective: To investigate the association between cognition and waist circumference (WC), an alternative measure of body fat which can be measured easier than body mass index (BMI), among older adults in each generation of late-life for men and women separately.Methods: Three hundred thirty-five participants were used in the current study who were identified by random sampling of residents aged 65-74, 75-84, and 85 + years in Takashima County, Shiga Prefecture, Japan during 2005-2006. Associations between WC and domain-specific cognitive functions measured by 12 neuropsychological tests were examined using multivariable linear regression models with covariates: age, education, and hypertension.Results: Larger WC was associated with better attention/working memory among 65-74-year old women and with better learning/acquisition among 65-74-year-old men, while larger WC was associated with worse learning/acquisition, memory, attention/working memory, and language/fluency among 75-84-year old men.Conclusion: We found age and sex differences in the association between WC and domain-specific cognitive functions. Among older old men (age 75-84), larger WC had negative effects on various domains including memory, attention, language, and executive functions, while we did not find any negative effects of larger WC on cognition among women in any age groups. [ABSTRACT FROM AUTHOR]

Background: The United Nations Decade of Healthy Ageing 2021-2030 suggests nations should monitor functional ability as an indicator of healthy ageing progress. Functional ability is the attribute of people to do something they value and consists of five domains. We examined its validity in terms of a construct, cross-validation across multiple waves' data, and predictivity for subsequent well-being., Methods: Using panel data from 35,093 community-dwelling adults aged ≥65 years from the Japan Gerontological Evaluation Study, we performed factor analyses to explore the construct of functional ability domains in both 2013 and 2016. A modified Poisson regression analysis was employed to test their associations with well-being (subjective health and happiness) in 2019., Results: The mean age (standard deviation) of participants was 72.1 (5.0) years, and 52.0% were women. A total of 85.0% reported good subjective health, and 50.6% reported high happiness levels. Factor analyses with 31 logically checked candidate items from 2016 data suggested a three-factor model comprising 24 items, which were compatible with the 2013 data results. Based on the World Health Organization's original domains, we named domains as domain #1: ability to build and maintain relationships; domain #2: ability to meet basic needs + ability to move around and domain #3: ability to learn, grow and make decisions + ability to contribute. All three domains predicted both subjective health and happiness in 2019., Conclusions: Empirical data from Japan supports the functional ability concept among older individuals. Validating this concept with data from other nations is warranted., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: The present study was carried out to determine the reference ranges of 43 frequently used blood tests in daily practice for physically independent patients of advanced age. Methods: We identified all patients aged ≥20 years who underwent groin hernia repair at Itoigawa General Hospital in Niigata, Japan. The patients' characteristics, preoperative data and prescribed medications were obtained by reviewing the electronic medical records. Results: Of 284 patients, 266 with independence in activities of daily life were included in the present study: 72 were assigned to the younger adult group (age 20–64 years), 86 were assigned to the older adult group (age 65–74 years) and 108 were assigned to the advanced age group (age ≥75 years). Patients in the advanced age group had a lower body mass index, less alcohol consumption, more hypertension, lower respiratory function and higher frequency of multidrug therapy. The multiple regression analysis showed significant differences in albumin, gamma‐glutamyl transpeptidase, cholinesterase, estimated glomerular filtration rate, uric acid, triglyceride, calcium, phosphate, magnesium and peripheral blood cell counts between the advanced age group and the other two age groups. Conclusions: We identified age‐dependent changes in several blood tests among physically independent adults. These results will help to guide accurate interpretation of laboratory results and properly manage patients in geriatric medicine. Geriatr Gerontol Int 2019; 19: 780–785. [ABSTRACT FROM AUTHOR]

• Social network sizes were significantly smaller in people with hearing impairment. • People with hearing impairment had fewer relationships with non-kin. • Hearing impairment may be associated with elderly people's social relationships. Hearing impairment (HI) is a major global health concern. In addition, social networks are important for healthy aging. This study aimed to examine the association between HI and social relationships. This study was conducted by the National Institute for Longevity Sciences as part of its Longitudinal Study of Aging with 1176 Japanese participants aged 60 years or older (mean age 71.0 ± 7.4). The convoy model was used to evaluate participants' network size. A pure-tone average hearing level (HL) of 0.5, 1, 2, and 4 kHz in the better ear >25 dB HL was defined as HI. Multivariate analysis was performed to assess the relationship between HI and the network size, adjusting for age, gender, years of education, presence of depressive symptoms, and higher-level functional capacity score. The mean network sizes across the three circles of the convoy model differed significantly by HI status (18.7 ± 0.4 in the no-HI group vs 17.0 ± 0.5 in the HI group, p = 0.003). In particular, the number of non-kin in the outer circle was significantly less in the HI group (4.1 ± 0.2 vs 3.3 ± 0.3, p = 0.004). The social network size was significantly smaller in the HI group. The outer circle of people to whom the individual feels less close and the number of non-kin were related to the presence of HI. Therefore, HI may be associated with elderly people's social relationships. [ABSTRACT FROM AUTHOR]

This study examined the associations of time spent out of home with physical activity and sedentary behavior among middle-aged and older adults. A diary survey was conducted for 7 days with 157 adults to measure out-of-home time and working status. Time spent in sedentary behavior and levels of physical activity were measured using an accelerometer. After a year, 137 individuals from the original sample participated in a follow-up survey. From the daily analyses of 535 non-working days and 347 working days, multilevel models revealed that on non-working days, more out-of-home time was associated with less sedentary time and higher levels of physical activity at both within- and between-person levels. Longitudinal analyses of non-working days supported these results. However, on working days, similar associations were not revealed by daily or longitudinal analyses. These results suggest that increasing out-of-home time could contribute to increased physical activity and reduced sedentary behavior on non-working days. [ABSTRACT FROM AUTHOR]

Introduction: Engaging in social activities is an essential component of a healthy lifestyle for community-dwelling older adults. Critically, as with past disasters, there is concern about the effects of long-term activity restrictions due to the coronavirus disease 2019 (COVID-19) pandemic on health of older adults. However, the precise associations between fear of COVID-19, lifestyle satisfaction, leisure activities, and psychological distress are unclear., Objective: The purpose of this study was to comprehensively determine the associations between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress among community-dwelling older adults in the context of the ongoing COVID-19 pandemic., Materials and Methods: A questionnaire survey administered by mail was conducted from October 1 to October 15, 2021. The questionnaire included the Fear of COVID-19 Scale, the Lifestyle Satisfaction Scale, the Leisure Activity Scale for Contemporary Older Adults, and the Kessler Psychological Distress Scale-6. Based on previous studies, we developed a hypothetical model for the association between fear of COVID-19, lifestyle satisfaction, leisure engagement, and psychological distress and performed structural equation modeling to assess the relationships between these variables., Results: Participants included 301 Japanese citizens (23.6% male, 76.4% female), with a mean age of 76.7 ± 4.58 years. Goodness-of-fit from structural equation modeling was generally good. Analysis of standardized coefficients revealed a significant positive relationship between fear of COVID-19 and psychological distress (β = 0.33, p < 0.001) and lifestyle satisfaction and leisure activities (β = 0.35, p < 0.001). We further observed a significant negative relationship between fear of COVID-19 and lifestyle satisfaction (β = -0.23, p < 0.001) and between leisure activities and psychological distress (β = -0.33, p < 0.001)., Conclusion: Fear of COVID-19 is significantly associated with psychological distress, both directly and via its effects on lifestyle satisfaction and leisure activities. That is, not only did fear of COVID-19 directly impact psychological distress of participants, it also affected psychological distress through lifestyle disruption and leisure restriction. This results may be used to better understand how a national emergency that substantially restricts daily life, such as COVID-19 or an earthquake disaster, can affect the psychological health and wellbeing of older, community-dwelling adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zenba, Kobayashi and Imai.)

Background: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework., Objective: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity., Methods: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021., Results: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff., Conclusions: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults., (©Vera Stara, Luca Soraci, Eiko Takano, Izumi Kondo, Johanna Möller, Elvira Maranesi, Riccardo Luzi, Giovanni Renato Riccardi, Ryan Browne, Sébastien Dacunha, Cecilia Palmier, Rainer Wieching, Toshimi Ogawa, Roberta Bevilacqua. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.10.2023.)

Social participation is effective for preventing functional decline in older people. However, researchers have not fully explored how different frequencies of social participation by type. We aimed to clarify the relationship between the frequency of social participation by type and functional decline. We used data from the Japan Gerontological Evaluation Study, which consists of individuals aged 65 years and older who were not eligible to receive public long-term-care insurance benefits. From 13 municipalities, 51,968 respondents who met the criteria were included in the analysis. We used a sex-stratified Cox proportional hazards model. The outcome was the new incidence of functional decline during a six-year follow-up, and the exposure was the frequency of social participation of one of the following six types: sports, hobbies, volunteering, neighborhood, senior clubs, and industry groups. The frequency was categorized as "never," "a few times a year," "once or twice a month," and "once a week or more." We set non-participation in each activity as the reference, and we adjusted for 12 potential confounders (i.e., sociodemographic and health-related factors). After we adjusted for confounders, participation in sports and hobbies once or twice a month, once a week or more was protectively associated with functional decline. We found a similar association for participation in neighborhood a few times a year. Our findings demonstrate the importance of considering the effects of different types and frequencies of activities when promoting social participation among older people as part of public health policies., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

• There is a paucity of research about the role of job participation in health and well-beings of older people. • A longitudinal study revealed increased frequency of job participation was associated with better self-rated health and happiness and reduced risk of depression. • Subgroup analyses showed the association differed based on age-groups and gender. We investigated the association between the frequency of job participation and well-being among older people in Japan, using data from a prospective nation-wide survey, the Japan Gerontological Evaluation Study (JAGES). The frequency of work was classified into "not working," "sometimes or less" (≤3 times/week), and "often or more" (≥4 times/week), and we conducted binary and continuous outcome analyses using logistic or Poisson regression and linear regression. After adjusting for covariates, we have found that participants who worked "often or more" and "sometimes or less" were less likely to display poor subjective health (often or more = odds ratio (OR): 0.55, 95% confidence interval (CI): 0.48 to 0.62; sometimes or less = OR: 0.57, 95% CI: 0.49 to 0.67) and depression (often or more = OR: 0.62, 95% CI: 0.53 to 0.73; sometimes or less = OR: 0.58, 95% CI: 0.47 to 0.71), and more likely to be happy (often or more = prevalence ratio (PR): 1.05, 95% CI: 1.03 to 1.07; sometimes or less = PR: 1.03, 95% CI: 1.00 to 1.05). Linear regression analysis of ordinal discrete outcomes showed similar trends, and furthermore suggested that more work conferred more benefits. The participants who worked "often or more" were less likely to have poor subjective health and were happier than those who worked "sometimes or less" (linear coefficients of −0.04 and 0.15 respectively). Further research is required to investigate possible explanations for the association between frequent job participation and health and well-being at older ages. [ABSTRACT FROM AUTHOR]

People are living longer, and our life has become more digital. Hence, the benefits from digital technology, including economic growth, increasing labor productivity, and ensuring health equity in the face of an aging population emerged as a vital topic for countries around the world. Japan, the Republic of Korea (ROK), Singapore, and Thailand are in the top ten rankings in terms of information and communication technology (ICT) development within the Asia Pacific Region and all are facing challenges of population aging. Well-designed national ICT policy and health promotion policies enabled the countries to make significant progress and development in terms of digitalization and healthy aging. This paper aims to answer questions regarding digitization and health promotion: when it started, how it is going, what are the achievements, and what it holds for the future, considering healthy aging and digitalization by reviewing the national ICT policy and health promotion policies of Japan, Korea, Singapore, and Thailand. This paper is expected to help readers build a comprehensive understanding of each country's journey towards building a healthy aging digital society. Furthermore, we hope this paper can be a source for countries to exchange experiences and learn from each other with a joint goal of building a healthy aging digital society.

Background and Objectives: Health-related expectations regarding aging is a gerontological construct that is potentially predictive of morbidity and mortality in later life. The Expectations Regarding Ageing scale (ERA-12) is a widely used measure of health-related expectations, although it has not previously been administered in Japanese. The present research aimed to elucidate the psychometric properties of the first Japanese translation of the ERA-12 and evaluate health-related expectations among middle-aged and older Japanese., Research Design and Methods: Repeated online surveys were conducted with representative quota samples of middle-aged and older adults in Tokyo during 2021 ( N = 1600). Primary outcome measures included total and subscale scores on a Japanese translation of the ERA-12 (ERA-12-J) addressing perceptions of physical, mental, and cognitive health. Standard measures were also used to gather information regarding respondent demographic details, general health, and health-related behavior., Results: The ERA-12-J and associated subscales showed acceptable test-retest reliability ( t (1598) = 0.60, p = 0.63), internal consistency (α > 0.80), inter-item correlation ( r = 0.21-0.78) and item-total correlation ( r = 0.53-0.73). Confirmatory Factor Analysis verified the hypothesized three-factor structure and construct validity on four common indices of fit (GFI = 0.968; CFI = 0.978; AGFI = 0.950; RMSEA = 0.059). ERA-12-J scores among Japanese respondents revealed prevailing negative sentiments concerning physical and cognitive health, with less negative sentiment regarding mental health. Significant and independent differences emerged concerning gender and age cohort, with middle-aged adults and females holding more negative expectations about their future health., Discussion and Implications: The ERA-12-J provides a sound basis for the elucidation of health-related expectations about aging in Japan and a useful tool for international comparative studies. Education and workplace intervention may be required in Japan to address age and gender disparities in health-related expectations.

One out of three people in Japan will be an older person before 2040. Half of those currently do not utilize the internet, smartphone apps, or digital technology. On the other hand, more than 70% of seniors in Republic of Korea use the internet, and 55% in Singapore had access to it in 2019. The use of digital technology for health promotion has the potential to promote individual and community empowerment, advocating for healthy, active aging. Maintaining equity in health promotion practice requires the digital inclusion of every senior. Therefore, we propose a cross-cultural study to explain the contextual influences of digital inclusion and its consequences on healthy aging in Japan, Korea, Singapore, and Thailand. Quantitatively: digital skills, e-health literacy, participation in health promotion, and quality of life will be analyzed in structural equation models. Qualitatively: thematic analysis will be developed to identify cultural patterns and contextual factors, making sense of what older persons in different countries materialize, say, do, think, and feel to reveal deeper beliefs and core values about digital inclusion and healthy aging. Logics and methods from this protocol would be useful to replicate the study in many countries globally. Evidence from this study is expected to pave the way to digitally inclusive, healthy aging communities (DIHAC) across Japan and Asia.

Background. Little is known regarding the normative levels of leisure activities among the oldest old and the factors that explain the age-associated decline in these activities. Methods. The sample included 303 cognitively intact community-dwelling elderly persons with no disability in Activities of Daily Living (ADL) and minimal dependency in Instrumental ADL (IADL) in Shiga prefecture, Japan. We examined (i) the nature and frequency of leisure activities, comparing the oldest old versus younger age groups; (ii) factors that explain the age-associated differences in frequencies of engagement in these activities; and (iii) domain-specific cognitive functions associated with these activities, using three summary index scores: physical and nonphysical hobby indexes and social activity index. Results. The oldest old (85 years old or older) showed significantly lower frequency scores in all activity indexes, compared with the youngest old (age 65-74 years). Gait speed or overall mobility consistently explained the age- associated reduction in levels of activities among the oldest old, whereas vision or hearing impairment and depressive symptoms explained only the decline in social activity. Frequency of engagement in nonphysical hobbies was significantly associated with all cognitive domains examined. Conclusions. Knowing the factors that explain age-associated decline in leisure activities can help in planning strategies for maintaining activity levels among elderly persons. [ABSTRACT FROM AUTHOR]

Background. As elite representatives of the rapidly increasing "oldest-old" population, centenarians have become an important model population for understanding human aging. However, as we are beginning to understand more about this important phenotype, another demographic group of even more elite survivors is emerging-so-called "super- centenarians" or those who survive 110-plus years. Little is known about these exceptional survivors. Methods. We assessed the Okinawa Centenarian Study (OCS) database for all information on supercentenarians. The database includes dates of birth and year of death for all residents of Okinawa 99 years old or older and a yearly geriatric assessment of all centenarians who consented, enabling prospective study of age-related traits. Of 20 potential supercentenarians identified, 15 had agreed to participate in the OCS interview, physical examination, and blood draw. Of these 15, 12 (3 men and 9 women) met our age validation criteria and were accepted as supercentenarians. Phenotypic variables studied include medical and social history, activities of daily living (ADLs), and clinical phenotypes (physiology, hematology, biochemistry, and immunology). Results. Age at death ranged from 110 to 112 years. The majority of supercentenarians had minimal clinically apparent disease until late in life, with cataracts (42%) and fractures (33%) being common and coronary heart disease (8%), stroke (8%), cancer (0%), and diabetes (0%) rare or not evident on clinical examination. Functionally, most supercentenarians were independent in ADLs at age 100 years, and few were institutionalized before the age of 105 years. Most had normal clinical parameters at age 100 years, but by age 105 exhibited multiple clinical markers of frailty coincident with a rapid ADL decline. Conclusion. Supercentenarians displayed an exceptionally healthy aging phenotype where clinically apparent major chronic diseases and disabilities were markedly delayed, often beyond age 100. They had little clinical history of cardiovascular disease and reported no history of cancer or diabetes. This phenotype is consistent with a more elite phenotype than has been observed in prior studies of centenarians. The genetic and environmental antecedents of this exceptionally healthy aging phenotype deserve further study. [ABSTRACT FROM AUTHOR]

Objectives　This study aimed to investigate whether health inequalities among communities would be reduced by intensively enhancing the "Kayoinoba" program in model communities where many high-risk, older adults live.Methods　Kobe City and the Japan Gerontological Evaluation Study created a mail survey for older adults in 78 communities (community ≈ junior high school district) to conduct community diagnosis. Sixteen communities showed poor values along multiple dimensions of risk and required priority measures. From 2014 to 2019, we designated these 16 communities as model communities. Then, municipal officials and researchers cooperated to support the establishment and management of "Kayoinoba." By using four-waves of mail survey data (in 2011, 2013, 2016, and 2019 with n=8,872, 10,572, 10,063, and 5,759, respectively), secular transitions of nine intermediate outcome indicators (three=social participation, two=social network, and four=social support) and five health outcome indicators (physical function, malnutrition, oral function, cognitive function, and depressive symptoms) were compared between model (n=16) and non-model (n=62) communities via multilevel mixed-effects linear regression analysis.Results　In the 2011 and 2013 surveys, model communities showed poor value compared to the non-model communities in 13 of the 14 indicators. A significant interaction between the year and model/non-model communities was confirmed for four intermediate outcome indicators (sports and hobby group participation, number of friends met, and providing emotional support) and three health outcome indicators (oral function, cognitive function, and depressive symptoms). The differences were reduced or eliminated in the 2016 and 2019 surveys. For example, hobby group participation in 2011 was 29.7% vs. 35.0% in model vs. non-model communities; the difference narrowed to 35.2% vs. 36.1% (P=0.008). Similarly, providing emotional support increased from 83.9% vs. 87.0% to 93.3% vs. 93.3% (P=0.007). Depressive symptoms decreased from 31.4% vs. 27.2% to 18.6% vs. 20.3% (P<0.001).Conclusions　Promoting community gathering places "Kayoinoba" for six years in communities where many high-risk older adults live may foster social participation, networking, and support and may help reduce health inequalities among communities.

There has been growing interest in the role of pet ownership, particularly dog ownership, in managing noncommunicable diseases. The built environment can act as a facilitator or barrier to owning a dog or dog walking. Nevertheless, limited studies conducted in different geographical contexts have examined how the built environment can influence dog ownership and dog walking. In this interdisciplinary article, using Japan as a case study, we identify key design challenges to owning and walking dogs in dense urban areas as a means of promoting health and wellbeing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Koohsari, Yasunaga, McCormack, Nakaya, Nagai and Oka.)

Ascertaining progress in building age-friendly cities (AFCs) requires community diagnostic indicators. This study examines the relationship between social participation and happiness at the municipal level. The data from the Japan Gerontological Evaluation Study (JAGES) from 2013, 2016, and 2019, comprising 442,079 older people from 289 municipalities, are used. We also employ linear mixed-effects models to evaluate the association between social participation and happiness. In these models, we adjust for seven variables as potential confounders. This study reveals that the higher the social participation, except for neighborhood association, the higher the state of happiness ( B = 0.14-0.30). Our study suggests that social participation is useful, as a community diagnostic indicator, for monitoring the progress of building AFCs, developing strategies, and creating evidence.

As smoking cessation is crucial for both individual and public health, this study aimed to elucidate the association between changes in social capital and in terms of smoking at the level of municipal units in Japan. Using repeated cross-sectional data from the Japan Gerontological Evaluation Study, we analyzed data from adults aged 65 years or older from 69 municipal units that participated in two survey waves. We received valid responses from 91,529 and 86,403 older people in 2013 and 2019, respectively, and aggregated all variables by municipal units. For the dependent variable, we used the units' prevalence of smoking for both years. The independent variables were the percentages of social capital indicators, such as social participation, social cohesion, and reciprocity for each of the 69 municipal units. The mean prevalence of smoking increased from 9.7% in 2013 to 10.2% in 2019. Multiple regression analysis revealed that increases in the percentages of sports group participation, receiving emotional and instrumental social support, and reciprocity were significantly associated with decreased prevalence of smoking, after we adjusted for confounding variables. This study indicates that building social capital might be useful in promoting smoking cessation and that its indicators could be useful in monitoring efforts.

• Depression was associated with poor SRH in older Japanese and Koreans. • Income was associated with mental distress among only Korean elders. • Income security in old age is an important social policy for aging societies. Japan and South Korea, two neighbouring countries in East Asia, enjoy the highest life expectancies in the world, yet suffer paradoxically from high suicide rates. We sought to conduct a cross-national comparative analysis of depressive symptoms among older adults in Japan vs. Korea, focusing particularly on poverty and physical health status. We used nationally representative samples aged 65 and over from the Comprehensive Survey of Living Conditions in Japan and the Korean Community Health Survey in South Korea. Multivariate logistic regression models were conducted to examine if equivalized household income, poor self-rated health, disability and comorbidity (number of diseases) were associated with depressive symptoms, adjusting for age, education, marital status, alcohol use, smoking and living alone. Older Japanese adults with poor self-rated health and disability were more likely to report depressive symptoms, but income level was not significantly associated with mental distress. By contrast, among older Korean people, depressive symptoms were strongly patterned by household income level, as well as poor self-rated health, disability, and comorbidity. Poor physical health status was correlated with depressive symptoms among both Japanese and Korean seniors. However, income level was associated with depressive symptoms among only Korean elders, but not Japanese. Thus, the current generation of older Japanese adults appears to enjoy (relative) financial security, longevity, and mental wellbeing. By contrast, older Koreans experience high levels of mental distress, especially if they are financially insecure. [ABSTRACT FROM AUTHOR]

Background: Social frailty is associated with poor health outcomes; however, its effects on healthy aging indicators have not been adequately investigated. This study assessed the longitudinal association between social frailty and the intrinsic capacity of community-dwelling older adults., Methods: A total of 663 participants (56.7% women) aged ≥60 years from in Nagoya, Japan, were included in the study. The first measurement occurred in 2014, and annual follow-ups occurred until 2017. Social frailty was determined based on four items: financial difficulty, household status, social activity, and regular contact with others. A deficit score of 0 represented social robustness, 1 represented social prefrailty, and ≥ 2 represented social frailty. Intrinsic capacity was evaluated by the locomotion, cognition, psychological function, vitality, and sensory function domains. The longitudinal association was analyzed using generalized estimating equations., Results: The prevalence of social prefrailty and social frailty at baseline was 31.2 and 6.3%, respectively. The social prefrailty group (β = - 0.132, P < 0.001) and social frailty group (β = - 0.258, P < 0.001) were associated with a greater reduction in the composite intrinsic capacity scores than the social robustness group, especially in the cognition, psychological function, and vitality domains. Men with social prefrailty/social frailty demonstrated a greater decrease in the psychological function domain score (- 0.512 vs. - 0.278) than women. Additionally, the cognition domain score only decreased in men in the social prefrailty/social frailty group (β = - 0.122, P = 0.016)., Conclusions: Social frailty was associated with intrinsic capacity and its subdomains longitudinally. Men with social frailty were more vulnerable than women to a decline in their psychological function and cognition domains. Therefore, the advanced management of social frailty is necessary to facilitate healthy aging., (© 2021. The Author(s).)

Physical activity is associated with improvement in overall health and well-being, but robust evidence with comprehensive assessment of general health is lacking. This study aimed to clarify the effects of physical activity on intrinsic capacity among community-dwelling older adults with subjective memory concerns. A single-blind randomized controlled trial compared aerobic training (AT), resistance training (RT), and combined training (AT+RT) programs for improving general health evaluated by intrinsic capacity. Toyota, Japan. Residents (65–85 years old) who screened positive for subjective memory concerns using the Kihon checklist were invited for eligibility assessment. In total, 415 community-dwelling older adults were enrolled and randomized into the AT, RT, AT+RT, and control groups. Participants in the intervention groups underwent a group training program and self-paced home training for 26 weeks. The control group received lectures about health promotion. Intrinsic capacity (IC), constructed based on locomotion, cognition, psychological function, and vitality domains, was used to assess general health at baseline, week 26, and week 52. Between-group differences were exhibited with Z-score change in individual domain and combination of all domains. At baseline, mean age of all participants (47% women) was 72.3 ± 4.6 years, with a mean composited IC Z-score of −0.2 ± 0.5. Overall, AT and RT improved composite IC Z-scores by 0.17 (95% confidence interval [CI] 0.03–0.30) and 0.17 (95% CI 0.05–0.28) at week 26, respectively, but the beneficial effects waned at week 52. No significant differences in composite IC Z-scores were found in the AT+RT group at weeks 26 and 52. Twenty-six-week AT with self-paced home training and RT with self-paced home training improve IC among community-dwelling older adults with subjective memory concerns, but the benefits waned subsequently. It will be required to develop optimal interventions that have a continuous beneficial effect on IC among community-dwelling older adults. [ABSTRACT FROM AUTHOR]

This study analyzes the effect of social participation in a program that encourages participation in social activities as an approach to counteract the social isolation of elderly males in Japan. The design of this study was an open-label, before-and-after trial for a single group using the convergent design of the mixed-methods study. This program led to significant improvement in independent living and interest in society, but it did not help increase satisfaction with social activities. Additionally, a qualitative data identify that this program encouraged subjects to proactivity participate in social activities. While it has been identified that this program may have had a considerable effect by integrating quantitative and qualitative data, it is necessary to improve the program to further promote change in the subjects' social behavior.

Aim: Generativity is increasingly being recognized as a key element of healthy aging. The present study investigated whether children who received more positive grandparental involvement would show higher generativity in late life., Methods: In 2017, 173 older adults living in Wakuya City (Miyagi Prefecture, Japan), and who showed normal cognition based on the Quick Mild Cognitive Impairment Screen, participated in a self-report life course survey (age range: 65-88 years). The association between positive grandparental involvement in childhood and generativity (measured by the Loyola Generativity Scale) was investigated using multiple linear regression adjusted for potential confounders., Results: Compared with older adults without or had low positive grandparental involvement in childhood, a higher level of generativity was observed among those with medium (β = 1.93, 95% confidence interval [CI]: 0.24-3.62) and high positive grandparental involvement (β = 2.09, 95% CI: 0.32-3.87), adjusting for age, gender, memory performance, depressive symptoms, childhood socio-economic status and parental involvement. The significant dose-response association remained even after further adjusting for education and current grandparental experiences., Conclusion: Greater positive grandparental involvement in childhood was associated with a higher level of generativity among community-dwelling, cognitively intact, Japanese older adults. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••., (© 2021 Japan Geriatrics Society.)

Japan's aging population and increasing medical costs threaten the sustainability of its healthcare system. Society 5.0, Japan's growth strategy, calls for a paradigm shift in healthcare based on digital technology. Health is a topic of great public concern, and diet and nutrition are at the heart of health. Many different values are used to define health, and Society 5.0 focuses on creating personalized values for different styles of eating and health. Health is already at the core of global business, and Japan, which is ahead of the rest of the world in its super-aging society, has a unique opportunity to be the first to create new business solutions for diet and nutrition., (© The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Population aging is a global phenomenon, and Japan is one of the front-runners of rapidly aging societies. In 2030, one-third of the Japanese population will be at least 65 years of age and 20% will be at least 75 years of age. The working age population is shrinking. Healthy aging is a crucial issue for both individual well-being and the sustainability of society. Along with biomedical research, the importance of the living environment and lifestyle has been long recognized and extensively studied. The issues have been identified and now it is time to establish solutions and actions - action-targeted research. The Institute of Gerontology at the University of Tokyo launched a social experiment, redesigning existing communities where people could live for 100 years and remain healthy, active, and connected, while still maintaining a sense of security. This requires co-creation by citizens, researchers, government, and industry. The ultimate goal is to make linkages among longevity, health, and wealth, and to build a sustainable society., (© The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Uniform international measurement tools for assessing healthy ageing are currently lacking., Objectives: The study assessed the novel comprehensive global Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) Healthy Ageing Scale, using an Item Response Theory approach, for evaluating healthy ageing across populations., Design: Pooled analysis of 16 international longitudinal studies., Setting: 38 countries in five continents., Subjects: International cohort (n=355 314), including 44.4% (n=153 597) males, aged (mean±SD) 61.7±11.5 years old., Methods: The ATHLOS Healthy Ageing Scale (including 41 items related to intrinsic capacity and functional ability) was evaluated in a pooled international cohort (n=355 314 from 16 studies) according to gender, country of residence and age group. It was also assessed in a subset of eight cohorts with ≥3 waves of follow-up assessment. The independent samples t-test and Mann-Whitney test were applied for comparing normally and skewed continuous variables between groups, respectively., Results: The ATHLOS Scale (range: 12.49-68.84) had a mean (±SD) value of 50.2±10.0, with males and individuals >65 years old exhibiting higher and lower mean scores, respectively. Highest mean scores were detected in Switzerland, Japan and Denmark, while lowest in Ghana, India and Russia. When the ATHLOS Scale was evaluated in a subset of cohorts with ≥3 study waves, mean scores were significantly higher than those of the baseline cohort (mean scores in ≥3 study waves vs baseline: 51.6±9.4 vs 50.2±10.0; p<0.01)., Conclusions: The ATHLOS Healthy Ageing Scale may be adequately applied for assessing healthy ageing across populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

(1) Background: This study aims to examine the association between service quality for sports and active aging and the impacts on different age cohorts; (2) Methods: This cross-sectional study used a convenience sample of 545 Japanese community sports club (CSC) members over 60 years old, recruited from across eight CSCs in Japan between 2012-2013. A self-administered questionnaire was used to measure the self-reported health status of the elderly, evaluations to CSCs, demographic characteristics, and information on sports programs; (3) Results: The results of multiple logistic regression showed that domains of general evaluation for sports (OR = 1.942 and 95% CI 1.336~2.824), benefits of sports (OR = 1.659 and 95% CI 1.344~2.047), and management in sports (OR = 1.273 and 95% CI 1.011~1.603) were important for club members aged 60-64, the young-old, and the old-old, respectively. With a reduced model for elderly members, stratified analyses showed a significant impact of service quality for sports on active aged people in the benefits and management domains, regardless of sociodemographic information or club participation behavior; (4) Conclusions: The findings suggest that the services encountered in sports are key to promoting health in a community. Service quality in age segmentation should be considered to promote and manage active aging in the future.

With the advance of medical care, the duration of dependency on nursing care in later life has increased worldwide. There is a question of whether farm work could extend or shorten the dependency duration. We investigated the association between farm work experience and the duration of dependency on nursing support or care in late life.We randomly selected 600 adults aged ≥65 years, who were independent and not hospitalized, as part of the Yamanashi Healthy-Active Life Expectancy cohort and followed them for 13 years. We defined the duration of dependency as the time from reception of long-term care insurance benefits to death, and we adjusted for multiple covariates.We analyzed data from 225 adults (139 men and 86 women) who died during the follow-up period. Ninety four had received long-term care benefits. Mean age was 79.6 years (standard deviation [SD]: 6.3) in individuals with farm work experience and 80.1 years (SD: 7.2) in individuals without farm work experience. The estimated duration of dependency on long-term care was 1.3 years (standard error [SE]: 0.4) in individuals with farm work experience vs 2.1 years (SE: 0.5) in individuals without farm work experience (P = .01). The estimated duration of dependency in individuals with farm work experience and without farm work experience was 0.4 years (SE: 0.5) vs 1.3 years (SE: 0.6) in men respectively (P = .03) and 1.6 years (SE: 0.9) vs 2.4 years (SE: 0.9) in women, respectively (P = .16). The sensitivity analysis yielded an estimated duration of 1.2 years (SE: 0.5) in those with farm work experience and 2.3 years (SE: 0.5) in those without farm work experience (P = .004).Individuals with farm work experience required less long-term care prior to death, suggesting that agricultural and physical activities promote health. Policymakers focusing on preventing the need for nursing care in older populations could consider promoting farming or gardening.

Background: Research has suggested the positive impact of physical activity on health and wellbeing in older age, yet few studies have investigated the associations between physical activity and heterogeneous trajectories of healthy ageing. We aimed to identify how physical activity can influence healthy ageing trajectories using a harmonised dataset of eight ageing cohorts across the world., Methods: Based on a harmonised dataset of eight ageing cohorts in Australia, USA, Mexico, Japan, South Korea, and Europe, comprising 130,521 older adults (M age  = 62.81, SD age  = 10.06) followed-up up to 10 years (M follow-up  = 5.47, SD follow-up  = 3.22), we employed growth mixture modelling to identify latent classes of people with different trajectories of healthy ageing scores, which incorporated 41 items of health and functioning. Multinomial logistic regression modelling was used to investigate the associations between physical activity and different types of trajectories adjusting for sociodemographic characteristics and other lifestyle behaviours., Results: Three latent classes of healthy ageing trajectories were identified: two with stable trajectories with high (71.4%) or low (25.2%) starting points and one with a high starting point but a fast decline over time (3.4%). Engagement in any level of physical activity was associated with decreased odds of being in the low stable (OR: 0.18; 95% CI: 0.17, 0.19) and fast decline trajectories groups (OR: 0.44; 95% CI: 0.39, 0.50) compared to the high stable trajectory group. These results were replicated with alternative physical activity operationalisations, as well as in sensitivity analyses using reduced samples., Conclusions: Our findings suggest a positive impact of physical activity on healthy ageing, attenuating declines in health and functioning. Physical activity promotion should be a key focus of healthy ageing policies to prevent disability and fast deterioration in health.

Background: The rapid growth of the size of the older population is having a substantial effect on health and social care services in many societies across the world. Maintaining health and functioning in older age is a key public health issue but few studies have examined factors associated with inequalities in trajectories of health and functioning across countries. The aim of this study was to investigate trajectories of healthy ageing in older men and women (aged ≥45 years) and the effect of education and wealth on these trajectories., Methods: This population-based study is based on eight longitudinal cohorts from Australia, the USA, Japan, South Korea, Mexico, and Europe harmonised by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. We selected these studies from the repository of 17 ageing studies in the ATHLOS consortium because they reported at least three waves of collected data. We used multilevel modelling to investigate the effect of education and wealth on trajectories of healthy ageing scores, which incorporated 41 items of physical and cognitive functioning with a range between 0 (poor) and 100 (good), after adjustment for age, sex, and cohort study., Findings: We used data from 141 214 participants, with a mean age of 62·9 years (SD 10·1) and an age range of 45-106 years, of whom 76 484 (54·2%) were women. The earliest year of baseline data was 1992 and the most recent last follow-up year was 2015. Education and wealth affected baseline scores of healthy ageing but had little effect on the rate of decrease in healthy ageing score thereafter. Compared with those with primary education or less, participants with tertiary education had higher baseline scores (adjusted difference in score of 10·54 points, 95% CI 10·31-10·77). The adjusted difference in healthy ageing score between lowest and highest quintiles of wealth was 8·98 points (95% CI 8·74-9·22). Among the eight cohorts, the strongest inequality gradient for both education and wealth was found in the Health Retirement Study from the USA., Interpretation: The apparent difference in baseline healthy ageing scores between those with high versus low education levels and wealth suggests that cumulative disadvantage due to low education and wealth might have largely deteriorated health conditions in early life stages, leading to persistent differences throughout older age, but no further increase in ageing disparity after age 70 years. Future research should adopt a lifecourse approach to investigate mechanisms of health inequalities across education and wealth in different societies., Funding: European Union Horizon 2020 Research and Innovation Programme., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives　Comprehensive community sports clubs (CCSCs), of which more than 3,500 exist in Japan, have the potential to contribute to healthy aging in older adults, but their effect on this population has not, thus far, been well explored. This study aimed to investigate the current environment affecting seniors at Japanese CCSCs and to examine issues identified by the analysis.Methods　Data were collected from the FY 2016 Survey Results on Comprehensive Community Sports Clubs, conducted by the Japan Sports Agency. A total of 2,444 clubs were divided equally into four groups after calculating the proportion of senior members (ages 60 and over) per total number of members in each club. The groups were then ranked from lowest to highest according to proportion of senior members: Groups A, B, C and D. Additionally, the 2,444 clubs were classified into six regions according to location. Group designation (A to D) and regional classification were used as independent variables. The dependent variables were categorized as follows: basic information (e.g. total number of members), crisis management and accident prevention measures (13 specific items in total), and each club's compliance with legal obligations.Results　Study results revealed that Group D, containing the highest proportion of senior members, had fewer total members, lower monthly membership fees, lower annual club income, less annual club budget apportioned to each member, and fewer instructors than other groups. Regarding crisis management and accident prevention measures, Group D had lower completion rates on 6 items (health certificate submissions, liability insurance enrollment, safety workshop implementation, heatstroke prevention, liaison with healthcare professionals, and AED availability). Group D also showed a lower rate of compliance with legal obligations than other groups. In comparisons between the six regions, the median proportion of senior members was found to be highest in Chugoku-Shikoku and lowest in Chubu, although each median ranged from only 20% to 30%. Regarding crisis management and accident prevention measures, clubs in Kanto region had the highest completion rates for 10 items, whereas clubs in Kinki region had the lowest completion rates for 8 items.Conclusion　The CCSCs with higher proportions of senior members had smaller budgets, fewer members and staff, and delayed implementation of crisis management and accident prevention measures. Regional disparities were also observed both in club scale and management of medical and safety issues. Although our study identified several shortcomings in this area, medical and safety management implementation is an important consideration for CCSCs with high proportions of senior members, as these members are at higher risk for disease and frailty. Affected CCSCs and relevant authorities should therefore acknowledge and address this issue cooperatively.

The World Health Organization (WHO) argues that governments can postpone declining capacity of older adults by providing sufficient support. Yet, to our knowledge, no study has focused on the role of local governments for realizing healthy ageing. This study examined the association between the intensity of community-based programs for frailty postponement by long-term care insurers (as municipalities) and the likelihood of frailty. We analyzed repeated cross-sectional data of three waves (2010-11, 2013, and 2016) from the Japan Gerontological Evaluation Study (JAGES). Participants included 375,400 older adults aged 65 years or older (M = 74.1) living in a total of 81 regions covered by insurers in Japan. Frailty was assessed by a governmental standardized index, the Kihon Check List (KCL; a basic function check list in Japanese). Estimations were obtained using a multilevel logistic model with random slopes. We found that every social activity per hundred older people organized by a long-term care insurer was significantly associated with an 11% reduction of the likelihood of frailty (Odds ratio = 0.89; 95% credible interval = 0.81, 0.99). Although the main effect of educational events was not significant, the point estimate was slightly larger for people with lower levels of education than for those with higher education. The results also suggested that insurer-organized social activities could be more beneficial in communities with few opportunities for civic participation. The variation in intensity of community-based programs by long-term care insurers may explain part of a disparity in the likelihood of frailty between municipalities., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study sought to clarify the association between food store availability and the incidence of disability in older adults. This study utilized a population-based cohort study of independent Japanese adults aged ≥65 years, which was a 6 year follow-up of participants in the Japan Gerontological Evaluation Study. A total of 31,273 respondents were extracted. Food store availability was evaluated based on the existence of food stores within 500/1000 m of the home. We utilized participant-reported subjective measurement as well as geographic information system-based objective measurement for the evaluation. The incidence of disability was determined using municipal data on eligibility for long-term care insurance benefits. There were 7643 (24.4%) community-dwelling participants with low subjective food store availability and 5673 (18.1%) with low objective food store availability. During the follow-up period of 6 years, the cumulative incidence of disability was 20.9%, with a significant association between low subjective food store availability and increased disability. Participants who reported low subjective food store availability had a significantly higher likelihood of developing disability (hazard ratio = 1.18, 95% confidence interval: 1.11-1.25) than those who reported high subjective food store availability after adjusting for age, sex, sociodemographic status, environmental status, walking and going out, dietary food intake, body mass index, and comorbidities. Low subjective food store availability was associated with early onset of disability. Accessibility of food stores might contribute to maintaining a disability-free life., Competing Interests: The authors declare no conflicts of interest.

Problem: The measures for long-term care prevention that the Japanese government had introduced in 2006 were unsuccessful because of the failures to identify high-risk individuals and to enrol enough participants in the community prevention programme., Approach: The Japanese government shifted its primary strategy from a high-risk strategy to a community-based population strategy in 2015, by reforming the Long-term Care Insurance Act. This act is focusing on community-based care and social determinants of health. The Act and the government's plans for long-term care prevention are inspired by a social participation intervention called ikoino saron , that is gathering salons for people older than 65 years. These salons, managed by local volunteers, are held once or twice a month in communal spaces within walking distance of community members' homes and have a low participation fee. At the gatherings, older people can meet and interact with others through enjoyable, relaxing and sometimes educational programmes., Local Setting: Japan has the world's largest ageing population, with 27.7% (35.2 million/126.7 million) of people older than 65 years., Relevant Changes: Studies have shown that participation in the salons was associated with a halved incidence in long-term care needs and about one-third reduction in the risk of dementia onset. Evidence also suggests that financially vulnerable older adults were more likely to participate in such interventions. In 2017, 86.5% (1506/1741) of the Japanese municipalities had implemented the salons., Lessons Learnt: Integrated care for long-term care prevention should consider interventions targeting the whole community in addition to high-risk individuals.

Background: To let the early elderly live well, understanding how lifestyle and psychosocial factors related to a decline in competence in daily living is important., Methods: We investigated the associations between lifestyle and psychosocial factors at age 64 years and a decline in the Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≥ 2 points at age 70 years among the participants in comprehensive medical check-ups living in a city in Japan. Multivariable logistic regression analyses were performed separately for men and women., Results: Of the 1113 eligible men and 1203 eligible women, 110 men and 80 women showed a deteriorated competence in daily living during the 6 years. In men, risk was increased with ≥ 2 nighttime awakenings (multivariable odds ratio [mOR] 2.14, 95% confidence interval [CI] 1.19-3.86) and living alone (mOR 4.68, 95% CI 1.22-18.0), whereas risk was significantly decreased with a medium or fast gait (mOR 0.37 and 0.21, 95% CI 0.21-0.67 and 0.08-0.58) and high academic achievement (mOR 0.32 and 0.43, 95% CI 0.19-0.53 and 0.25-0.72). In women, risk was decreased with high life satisfaction (mOR 0.39, 95% CI 0.16-0.91) and participation in community activities (mOR 0.50, 95% CI 0.29-0.86) but increased with depressive mood (mOR 1.86, 95% CI 1.09-3.18)., Conclusion: Living alone for men and low life satisfaction for women at age 64 years were markedly associated with the risk of a subsequent declining competence in daily living.