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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. Probleme Les mesures pour la prevention des soins de longue duree qui avaient ete mises en place par le gouvernement japonais en 2006 ont ete inefficaces, en raison de l'impossibilite d'identifier les personnes a haut risque et de faire participer suffisamment de personnes au programme de prevention communautaire. Approche Le gouvernement japonais a change sa strategie premiere, d'abord axee sur les personnes a haut risque, pour l'orienter en 2015 vers une prise en charge dans la communaute, en reformant la loi relative a l'assurance pour soins de longue duree. Cette loi se concentre sur la prise en charge dans la communaute et sur les determinants sociaux de la sante. Elle s'inspire, comme les plans du gouvernement pour la prevention des soins de longue duree, d'une intervention pour la participation sociale appelee ikoino saron, qui consiste en des salons de reunion pour les personnes de plus de 65 ans. Ces salons sont organises une ou deux fois par mois par des benevoles locaux dans des espaces collectifs situes a une courte distance de marche, a un cout modique. ils permettent aux personnes asgees de se reunir et d'interagir avec d'autres personnes autour de programmes de loisirs, de detente et parfois d'etudes. Environnement local Le Japon est le pays du monde qui compte la population la plus asgee, avec 27,7% (35,2 millions/126,7 millions) de personnes de plus de 65 ans. Changements significatifs Des etudes ont montre que la participation a ces salons etait associee a une reduction de moitie de l'incidence des besoins en soins de longue duree et d'environ un tiers du risque de survenue de demence. Les donnees suggerent egalement que les adultes asges vulnerables sur le plan financier sont plus susceptibles de participer a ces interventions. En 2017, 86,5% (1506/1741) des municipalites japonaises avaient mis en place ce type de salons. Lecons tirees La prise en charge globale pour la prevention des soins de longue duree devrait envisager des interventions axees sur l'ensemble de la communaute en plus des personnes a haut risque. Situacion Las medidas de prevencion de cuidados a largo plazo que el gobierno japones habia introducido en 2006 no tuvieron exito debido a que no se identificaron a las personas de alto riesgo ni se inscribio a un numero suficiente de participantes en el programa de prevencion comunitaria. Enfoque El gobierno japones cambio su estrategia primaria de una estrategia de alto riesgo a una estrategia de poblacion basada en la comunidad en 2015, mediante la reforma de la Ley del Seguro de cuidado a largo plazo (Long-term Care Insurance Act). Esta ley se centra en la atencion basada en la comunidad y en los determinantes sociales de la salud. La ley y los planes del gobierno para la prevencion de los cuidados a largo plazo se inspiran en una intervencion de participacion social llamada ikoino saron, que reune salones para personas mayores de 65 anos. Estos salones, gestionados por voluntarios locales, se celebran una o dos veces al mes en espacios comunes a poca distancia y tienen una baja cuota de participacion. En las reuniones, las personas mayores pueden conocer e interactuar con otros a traves de programas divertidos, relajantes y a veces educativos. Marco regional Japon tiene la mayor poblacion de personas mayores del mundo, con un 27,7 % (35,2 millones/126,7 millones) de personas mayores de 65 anos. Cambios importantes Los estudios han demostrado que la participacion en los salones se asocio con una incidencia reducida a la mitad en las necesidades de cuidados a largo plazo y una reduccion de aproximadamente un tercio en el riesgo de aparicion de la demencia. La evidencia tambien sugiere que los adultos mayores vulnerables economicamente tenian mas probabilidades de participar en tales intervenciones. En 2017, el 86,5 % (1.506/1.741) de los municipios japoneses habian implementado los salones. Lecciones aprendidas La atencion integrada de prevencion de cuidados a largo plazo deberia considerar intervenciones dirigidas a toda la comunidad, ademas de a las personas de alto riesgo. [phrase omitted], Introduction Japan has the world's largest ageing population. In 2017, 27.7% (35.2 million/126.7 million) of people living in Japan were older than 65 years. Over the years, the Japanese government [...]

Background: Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study.Methods: Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years).Results: A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group.Conclusions: These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context. [ABSTRACT FROM AUTHOR]

Background: A life-course perspective is essential in understanding the determinants of higher-level functional limitations. We examine the impact of adverse childhood experiences (ACEs) on higher-level functional limitations in older people.Methods: Data were from the Japan Gerontological Evaluation Study 2013, a population-based cohort of independent people aged 65 years or older across Japan (n = 19,220). ACEs before the age of 18 were assessed in terms of seven adversities: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Associations between the cumulative number of ACEs and higher-level functional limitations were investigated by multivariate Poisson regression with robust error variances, adjusted for age, gender, childhood disadvantage, adult sociodemographics, adult health behaviors, and health status.Results: Of the older people, 36.3% reported at least one ACE. Older people who had experienced two or more ACEs showed significantly greater higher-level functional limitations than those with no ACE in a crude model (prevalence ratio, PR = 1.61, 95% confidence interval, CI = 1.51-1.71). After adjusting the covariates, this association remained (PR = 1.19, 95% CI = 1.12-1.27).Conclusions: ACEs showed robust independent effects on higher-level functional limitations among older Japanese without disabilities, even after adjusting for potential covariates in childhood and adulthood. The current findings may help in understanding the impact of the latent effects of ACEs on functional limitations in older people. [ABSTRACT FROM AUTHOR]

Objective: Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses., Design: Cross-sectional survey., Setting: Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022., Participants: This study included 28 617 Japanese adults aged 18-82 years (51.1% female; mean age=48.1 years)., Primary and Secondary Outcome Measures: The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models., Results: CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, ≥3 CPCEs (vs 0-2 CPCEs) lowered the adjusted prevalence by ≥50% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%)., Conclusion: CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and/or neighbourhoods are recommended., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objectives　Some young adults often tend to perceive interpersonal relationships and social interactions as stressful, and as such, avoid them. Seeking help from parents and interactions with neighbors during childhood are known to be important in forming positive impressions of people, thereby influencing help-seeking behavior in adulthood. However, it remains unclear how these experiences are related and how they influence interpersonal relationships in adulthood. This study aimed to investigate whether childhood experience(s) of social interactions in the community has any modifying effect on the association between seeking support from parents in childhood and avoidance of interpersonal relationships in adulthood.Methods　Data pertaining to 1,274 individuals (aged 18 to 39 years) were collected from a questionnaire survey conducted in 2018 by Nagoya City of Japan. Modified Poisson regression analyses were performed to estimate the prevalence ratio of current avoidance of interpersonal relationships depending on the experience(s) of seeking help from a parent (father/mother analyzed respectively) and participating in community events in childhood. Data were stratified according to gender, and adjusted for age, parents' educational background, mother's working status in childhood, subjective recognition of economic status in childhood and seeking help from the other parent. Effect estimates were calculated to evaluate the existence of any modifying effect.Results　No modifying effect of participating in community events in childhood was seen in the association between experience of seeking help from the father and current avoidance of interpersonal relationships, in either gender. Regarding experience of seeking help from the mother, a modifying effect was seen in men. Among men who had sought help from their mother, those who had participated in community events were less likely to avoid interpersonal relationships in adulthood.Conclusion　In order to reduce the tendency to avoid interpersonal relationships in adulthood, childhood experiences of seeking help from the mother and participating in community events may be important, particularly for men. In addition to appropriate parental support, promoting interactive events for children in communities may mitigate the problem of poor social skills later in life.

Background: Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study., Methods: Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years)., Results: A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group., Conclusions: These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context.

Background: A life-course perspective is essential in understanding the determinants of higher-level functional limitations. We examine the impact of adverse childhood experiences (ACEs) on higher-level functional limitations in older people., Methods: Data were from the Japan Gerontological Evaluation Study 2013, a population-based cohort of independent people aged 65 years or older across Japan (n = 19,220). ACEs before the age of 18 were assessed in terms of seven adversities: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Associations between the cumulative number of ACEs and higher-level functional limitations were investigated by multivariate Poisson regression with robust error variances, adjusted for age, gender, childhood disadvantage, adult sociodemographics, adult health behaviors, and health status., Results: Of the older people, 36.3% reported at least one ACE. Older people who had experienced two or more ACEs showed significantly greater higher-level functional limitations than those with no ACE in a crude model (prevalence ratio, PR = 1.61, 95% confidence interval, CI = 1.51-1.71). After adjusting the covariates, this association remained (PR = 1.19, 95% CI = 1.12-1.27)., Conclusions: ACEs showed robust independent effects on higher-level functional limitations among older Japanese without disabilities, even after adjusting for potential covariates in childhood and adulthood. The current findings may help in understanding the impact of the latent effects of ACEs on functional limitations in older people., (© The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)