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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 [...]

Aim: We prospectively examined the association between leisure activities and changes in instrumental activities of daily living (IADL) among participants of the Japan Gerontological Evaluation Study (JAGES). Methods: We analyzed data collected from 49 732 JAGES participants (23 359 men and 26 373 women), aged ≥65 years, from 24 municipalities in Japan. Measurements: Baseline data were obtained for 25 types of leisure activities in which the cohort members participated. Baseline (2010) and follow‐up (2013) data on IADL were collected – the outcome indicated changes in IADL scores from 2010 to 2013. We regressed changes in IADL scores from the 2010 to 2013 to the number of leisure activities. Results: Older adults who engaged in more leisure activities had higher changes in IADL scores than those who engaged in fewer leisure activities: the β values (95% confidence interval [CI]) of the IADL scores were 0.001 [−0.04–0.04], 0.04 [0.01–0.08], 0.09 [0.05–0.13], 0.09 [0.05–0.14], 0.08 [0.02–0.13], and 0.13 [0.07–0.18] for having one, two, three, four, five, and more than six types of leisure activities (P for trend <0.001), respectively. Similar associations were found for different types of leisure activities, including predominantly physical and cultural activities. Statistically significant linear trends were obtained among the group, solitary, and other leisure activity subgroups (P for trend <0.05). Conclusions: Encouraging engagement in leisure activities may promote maintenance of IADL among older populations. Different types of leisure activities appear to have similar positive impacts on IADL. Geriatr Gerontol Int 2022; 22: 152–159. [ABSTRACT FROM AUTHOR]

Aim: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people. Methods: Cross‐sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death. Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end‐of‐life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end‐of‐life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area. Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345–352. [ABSTRACT FROM AUTHOR]

In Japan, many adults prefer to die at home; however, few have their preferences actually come true. While discussions regarding place of death preferences (DPDPs) are important for older adults, they are poorly documented. Therefore, we investigated the factors associated with older Japanese men and women having DPDPs. We used cross-sectional survey data collected for the Japan Gerontological Evaluation Study (JAGES). We applied multivariable logistic regression analysis to calculate the odds ratio (ORs) of having DPDPs separately between men (n = 2,770) and women (n = 3,038) aged ≥ 75 years. We considered 17 potential factors associated with having DPDPs, which were classified as either demographic, healthcare, family, or community factors. Among participants, 50.1% had DPDPs: 1,288 men (44.3%) and 1,619 women (55.7%). Older adults, DPDPs were associated with 5 additional factors; e.g. having a primary care physician (ORs = 1.47 [men] and 1.45 [women]), as were those who gave family and friends advice (ORs = 1.26 [men] and 1.62 [women]), and having people who listened to their concerns (ORs = 1.70 [men] and 1.81 [women]). Among men, DPDPs were associated with 3 additional factors; e.g. humorous conversations with their spouse (OR = 1.60). Among women, only one factor—reading newspapers (OR = 1.43) was associated with having DPDPs. Social networks with primary care physicians, family members, and friends may be important factors in promoting DPDPs. These gender-based differences in older adults relating to DPDPs should be considered when developing interventions to promote advance care planning that includes DPDPs. [ABSTRACT FROM AUTHOR]

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.

Objectives　The Commission on Social Determinants of Health (CSDH) of the World Health Organization (WHO) recommends that national and municipal governments take adequate steps to "improve daily living conditions," "(create governance to) tackle the inequitable distribution of power, money, and resources," and "measure and understand the problem and assess the impact of" government actions. This study provides an analysis of the health promotion policies of Japan and other countries and examines their conformance to these recommendations, and offers suggestions for developing a conducive social environment for Japan's health promotion policies.Methods　We reviewed grey literature on health promotion policies in Japan, the USA, England, Sweden, and Thailand, extracting the definitions of health inequalities and their characterization in each policy, and analyzing each document vis-á-vis the CSDH's three recommendations and "comprehensive national health equity surveillance framework."Results　The health promotion policies of Japan, England, Sweden, and the USA had similar definitions of health inequality, emphasizing fairness and prioritizing the reduction of health inequality as the key strategy for health promotion. However, their primary approaches to improve daily living conditions varied: In Japan, the primary approach is to create opportunities for participation and ensure access to social resources. Meanwhile, the USA relies largely on objective assessments and scientific evidence-based actions. England focused on enhancing support for socially disadvantaged individuals and areas. In Sweden, a universal intervention based on life-course perspectives was stressed, while Thailand attached much value to a multi-sectoral collaboration. All these countries, however, had a health policy implementation plan in quest of the elimination of unfair distributions of power, money, and resources. The USA planned to monitor a total of 187 social factors, the largest number among the 6 subject countries. It also had a wide range of perspectives on health inequalities, including income and disability, as well as conducting assessments using information from outside the health sector, with items assessed at various levels, including individual, regional, and national policies.Conclusion　With reference to these approaches in other countries, for Japan's health promotion policies, we recommend: (1) grasping of health inequalities from more diversified perspectives and adopting measures to address them, (2) setting targets based on multi-level social determinants of individual behavior and health status, including individual socioeconomic status, and (3) promoting collaborative initiatives and use of indicators with entities outside the health sector.