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Background: Prognosis-related information regarding dementia needs to be updated, as changes in medical and long-term care environments for patients with dementia in recent decades may be improving the prognosis of the disease. Objective: We aimed to investigate the mortality, cause of death, and prognostic factors by types of dementia in a Japanese clinic-based cohort. Methods: The National Center for Geriatrics and Gerontology-Life Stories of People with Dementia consists of clinical records and prognostic data of patients who visited the Memory Clinic in Japan. Patients who attended the clinic between July 2010 and September 2018, or their close relatives, were asked about death information via a postal survey. A cohort of 3,229 patients (mean age, 76.9; female, 1,953) was classified into six groups: normal cognition (NC), mild cognitive impairment (MCI), Alzheimer’s disease (AD), vascular dementia, dementia with Lewy bodies (DLB), and frontotemporal lobar degeneration. A Cox proportional hazards model was employed to compare the mortality of each type of dementia, MCI, and NC. Results: Patients with all types of dementia and MCI had higher mortality rates than those with NC (hazard risks: 2.61–5.20). The most common cause of death was pneumonia, followed by cancer. In the MCI, AD, and DLB groups, older age, male sex, and low cognitive function were common prognostic factors but not presence of apolipoprotein E ɛ4 allele. Conclusion: Our findings suggest important differences in the mortality risk and cause of death among patients with dementia, which will be useful in advanced care planning and policymaking.

Despite a growing interest in decision-making by care recipients, few empirical studies have examined the everyday care decisions of community-dwelling older adults. This study aimed to examine the association of recipient- and caregiver-related factors with decision-making involvement of community-dwelling older care recipients.We conducted secondary data analysis using publicly available cross-sectional data from a dyadic survey with care recipients aged ≥65 years and their primary caregivers in two regions of Japan, one urban and another rural, in 2003. In total, 643 pairs with no missing data on any variable were included in the analysis. The level of care recipients' perceived decision-making involvement was assessed using one dichotomized item (not involved or involved). We examined care recipient- and caregiver-related factors described by previous studies as having the potential to inhibit or facilitate care recipient's subjective decision-making involvement.Of the care recipients, 60.2% were women, 72.2% were75 years, and 83.7% were involved in decision-making. Of the primary caregivers, 72.0% were women, 49.0% were65 years, and 47.9% were spouses. Multivariable logistic regression analysis showed that care recipients were more likely to be involved in decision-making when their caregivers respected their decisions (odds ratio = 3.03 [95% confidence interval: 1.90-4.86], P 0.001). Care recipients with more care needs were less likely to be involved in decision-making than those with less care needs (odds ratio = 0.53 [95% confidence interval: 0.32-0.89], P = 0.015).Our results suggest that family caregivers play a crucial role in increasing care recipients' decision-making involvement regarding daily care. Geriatr Gerontol Int 2022; 22: 876-882.

The growing ageing population has begun to pose a threat to global health due to social and psychological challenges experienced by older adults. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different cultural settings. We harmonised measures of hobby engagement and multiple aspects of mental health across 16 nations represented in five cohort studies. Fixed effects models and multi-national meta-analyses were applied to compare the longitudinal associations between hobbies and mental health internationally. Independent of confounders, having a hobby was associated with fewer depressive symptoms, and higher levels of self-reported health, happiness and life satisfaction. But prevalence of engagement and benefits correlated with macro-level factors such as life expectancy and national happiness levels. Consequently, ensuring equality in hobby engagement within and between countries should be the priority.

Objectives We aimed to examine the psychosocial characteristics of patients with rheumatoid arthritis (RA) by remission status and determine the impacts of social support on severity of depressive symptoms. Methods We enrolled RA patients aged 40–79 years who visited university hospitals’ outpatient clinics. Severity of depressive symptoms (Beck Depression Inventory-II), physical disability (Health Assessment Questionnaire), and support were evaluated. Furthermore, RA disease activity was evaluated by 28-point Disease Activity Score (DAS28) calculation. The independent impacts of instrumental and emotional social support on depressive symptoms by remission status defined as DAS28 score Results This study included 360 RA patients. In the remission group, emotional support showed a statistically significant negative impact on depressive symptoms, whereas instrumental support had an extremely limited contribution to severity of depressive symptoms. In the non-remission group, instrumental support showed a negative tendency of impact on severity of depressive symptoms, whereas emotional support had a wide range of influence. Conclusions Favourable association between emotional support and depressive symptoms is confirmed only among RA patients in remission status. The influence of emotional support in non-remission patients and that of instrumental support regardless of remission status are inconclusive.

Stroke is a major cause of disability in old age. Research has revealed that social resources available after the onset of stroke can mitigate functional prognosis. However, most studies have conceptualized resources as static rather than dynamic and have not measured changes in social resources from the pre-to post-stroke periods. To better understand the recovery process following stroke, we examined how social resources available before its onset and changes from pre-to post-stroke were associated with trajectories of functional health following stroke. Data were derived from an up to 19-year longitudinal study of a nationally representative sample of Japanese adults aged 60 years and older. We identified 389 people who experienced self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 75.9, SD = 6.8; 49.1% women). The average number of observations was 4.6 (SD = 1.6, range 2-7). Functional health was measured with self- or proxy-reported basic and instrumental activities of daily living. Social resources were indexed as residential status, contact with own non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, sex, education, health condition, and cognitive function. A multiphase growth model indicated that individuals who participated more frequently in social groups prior to stroke exhibited less functional deterioration post-stroke than those who participated less frequently. Whereas contact frequency with non-coresident children typically declined following stroke, the analysis further revealed that individuals who maintained contact frequency from pre-to post-stroke showed less steep functional decline over time in the post-stroke period despite minor individual differences. We found that social resources before stroke onset and changes in the resources following stroke may play a protective role against adverse prognoses. Inclusive communities may help older adults remain independent even after serious health events.

Reducing stigma against dementia is a global challenge, but the assessment scale is not well established. We examined the validity and reliability of the Japanese version of the assessment scale of public stigma against dementia.This study recruited 819 adults aged 20-69 years (mean age = 45.9 years; 52.0% females) through an internet survey, and 34 community-dwelling adults aged 20-78 years (mean age = 45.8 years; 55.9% females). Participants completed the Japanese version of the assessment scale of dementia stigma developed by Phillipson et al., with forward and back translations. In the internet survey sample, exploratory factor analysis was performed to verify factorial validity, and correlations with ageism and dementia attitudes were examined to test the concurrent validity. In the community sample, test-retest reliability was evaluated using intraclass correlation coefficients (ICCs) between two responses with a two-week interval.Factor analysis revealed a four-factor structure: "personal avoidance," "fear of labeling," "person centeredness," and "fear of discrimination" (Cronbach's α = 0.892, 0.840, 0.879, 0.829, respectively). Personal avoidance, fear of labeling, and fear of discrimination were positively correlated with ageism (r = 0.598, 0.214, 0.369) and negatively correlated with dementia attitudes (r = -0.745, -0.453, -0.475); person centeredness was inversely correlated with ageism (r = -0.322), but positively correlated with dementia attitudes (r = 0.537), showing good concurrent validity. The scale showed acceptable test-retest reliability (ICCs = 0.67-0.80).The Japanese version of the assessment scale of public stigma against dementia was established with good concurrent validity and adequate reliability. Geriatr Gerontol Int 2022; 22: 790-796.

Background While marriage and education help maintain older adults' health, their joint association with mortality remains unclear. This cross-national study examined the combined effect of marriage and education on the mortality of older Japanese and Finnish adults. Methods Data on 22,415 Japanese and 11,993 Finnish adults, aged 65-74 years, were obtained from the Japan Gerontological Evaluation Study of 2010-2012 and the Finnish Public Sector Study of 2008-2009 and 2012-2013. We followed up on respondents' survival status for 5 years using public records. Marital status, educational level, and other variables in both datasets were harmonized. Results The Cox proportional hazards model showed that unmarried men had a higher mortality risk than married men in both countries (hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.21-1.79 for Japanese and HR 1.94; 95% CI, 1.29-2.91 for Finnish); no such difference was observed in women. The highest mortality risk was observed in unmarried men with tertiary education in both Japan (HR 1.85; 95% CI, 1.21-2.83) and Finland (HR 2.21; 95% CI, 1.26-3.89), when adjusted for baseline age, health-related behaviors, and illnesses. Conclusions Our findings showed similarity in the combined effect of marriage and education between Japan and Finland, differing from observations in countries with more apparent socioeconomic health disparities. Further studies should examine the reasons for the excessive mortality risk in highly educated, unmarried men in both countries and consider whether selection bias led to underestimation of the true risk in unmarried older adults with lower education.

Background this study aimed to identify distinct subgroups of trajectories of disability over time before 3 years of death and examine the factors associated with trajectory group membership probabilities among community-dwelling Japanese older adults aged 65 years and above. Methods participants included 4,875 decedents from among community-dwelling Japanese older adults, aged ≥ 65 years at baseline (men: 3,020; women: 1,855). The certified long-term care levels of the national long-term care insurance (LTCI) system were used as an index of functional disability. We combined data from the 2010 Japan Gerontological Evaluation Study and data from the 2010 to 2016 LTCI system. Group-based mixture models and multinominal logistic regression models were used for data analysis. Results five distinct trajectories of functional disability in the last 3 years of life were identified: ‘persistently severe disability’ (10.3%), ‘persistently mild disability’ (13.0%), ‘accelerated disability’ (12.6%), ‘catastrophic disability’ (18.8%) and ‘minimum disability’ (45.2%). Multinominal logistic regression analysis found several factors associated with trajectory membership; self-rated health was a common predictor regardless of age and gender. The analysis also showed a paradoxical association; higher education was associated with trajectory group membership probabilities of more severe functional decline in men over 85 years at death. Conclusions individual perception of health was a strong predictor of trajectories, independent of demographic factors and socio-economic status. Our findings contribute to the development of policies for the long-term care system, particularly for end-of-life care, in Asian countries.

For older adults receiving long-term care (LTC) at home, little is known about the role of social function in the onset of adverse outcomes, such as death, institutionalization, and functional decline. We examined the association between social function and adverse outcome onset among community-dwelling older adults with mild care needs.This two-year longitudinal study recruited non-institutionalized older adults, with mild care need levels, in 2003. Participants were followed regarding the onset of death, institutionalization, and functional decline, after two years. Social function was assessed using four items (friendships, emotional support, instrumental support, and intergenerational interactions) and scored from zero (low) to four (high). Multivariable logistic regression analysis estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for the onset of adverse outcomes, composite of death, institutionalization, and functional decline.Ultimately, 281 older adults were analyzed. During the observation period, the onset of adverse outcomes was observed in 41.4% of the participants (death, 13.9%; institutionalization, 7.9%; functional decline, 19.5%). Higher social function was inversely associated with adverse outcome onset, even after adjusting for covariates including cognitive function (compared to zero point, ORs [95% CIs] were 0.85 [0.42-1.70] for one, 0.42 [0.19-0.94] for two, and 0.44 [0.20-0.99] for three or more; p = 0.018). Among the sub-items, friendships were associated with lower adverse outcome onset.Higher social functioning was associated with the low onset of adverse outcomes among older adults under LTC. Enhancing social functions, including friendships, may be crucial for prognosis in LTC.

The outbreak of the novel coronavirus (COVID-19) has exerted a major impact on daily life. Despite older adults being at a higher risk of severe illness from COVID-19, research has indicated that older adults experienced the same or even higher levels of well-being during the early phase of the pandemic than younger adults. To investigate adverse long-term effects, we examined how individuals’ well-being changed during the first year of the pandemic. A total of 5,281 Japanese adults aged 15—89 years participated in an online survey in February 2020 (before the first state of emergency) and were followed up in March 2021 (during the second state of emergency; follow-up rate 54.7%). Well-being was assessed as a one-item indicator of life satisfaction, with a range of 0－10. Counterintuitively, results of a latent change score model demonstrated that life satisfaction increased over time (unstandardized coefficient of 1.17, SE = 0.16, standardized coefficient of 0.58). Individuals aged 64 years and below, with low levels of education, living alone, and perceiving worse health and economic status showed less increase in life satisfaction. In an additional analysis, those more concerned about the pandemic at follow-up displayed less increase. The findings suggest that most people did not exhibit a decrease in life satisfaction during the first year of the COVID-19 pandemic. However, certain individuals could be vulnerable to the outbreak due to the lack of resources. Researchers should better understand the factors that drive the resilience of older adults in the face of adversity.

During the COVID-19 pandemic, informal caregivers’ mental health was more deteriorated than non-caregivers. The objective of this study was to examine the association between increased caregiver burden and severe psychological distress (SPD) during the pandemic. We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were analyzed (mean age, 52.3 ± 15.9 years; men, 48.8%). SPD was defined as the Kessler 6 Scale (K6) ≥ 13. The self-rated change in caregiver burden was measured with the single question item. A binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted in all variables. Of total caregivers, 56.7% reported the increased caregiver burden and 19.3% were SPD. Increased caregiver burden was significantly associated with SPD, with an adjusted odds ratio 1.90 (95% confidence interval 1.37–2.66). The association between increased caregiver burden and SPD was stronger among married caregivers, with disease treatment, and with their care-receiver’s care need level 1–2 (Japanese long term care service levels). This study demonstrated that increased caregiver burden was associated with SPD during the pandemic. Therefore, measures against mental health for the caregivers with increased caregiver burden need to be implemented immediately.

Overcoming stigma around dementia is a global challenge. This cross-sectional study examined the association of experiences of interacting with people with dementia (PwD) and learning about dementia, with the public-stigma against dementia. We recruited—via an internet survey—710 Japanese adults (mean age = 46.3 years; 49.3% females) without any medical or welfare license, or dementia-related work experience. Public-stigma against dementia was assessed using the Japanese version of Phillipson et al.’s scale (2012) exploring dementia-related attitudes in the context of “personal avoidance,” “person centeredness,” “fear of labeling,” and “fear of discrimination.” Multivariable linear regression analysis was employed to examine the association of interacting with PwD and learning regarding dementia as explanatory variables with dementia stigma score, adjusting for sociodemographic variables. Regarding interactions with PwD, talking or activities with PwD were associated with low “personal avoidance” (β = -1.47, p = 0.002), “fear of labeling” (β = -0.96, p = 0.020), and “fear of discrimination” (β = -0.396, p = 0.043). Experiences of living with PwD were associated with low “personal avoidance” (β = -2.35, p = 0.002) and “fear of discrimination” (β = -0.789, p = 0.013). Learning experiences at school regarding dementia were associated with low “personal avoidance” (β = -4.01, p < 0.001), and self-learning experiences were associated with low “personal avoidance” (β = -1.73, p = 0.049) and high “person centeredness” (β = 1.27, p = 0.037). However, workplace learning was not associated with any area. Interacting with PwD and learning about dementia might reduce associated public-stigma.

During the coronavirus disease 2019 (COVID-19) pandemic, informal caregivers' mental health deteriorated more than that of non-caregivers. We examined the association between increased caregiver burden during the pandemic and severe psychological distress (SPD).We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15-79 years, 1,920 informal caregivers were included. SPD was defined as Kessler 6 Scale (K6) score ≥ 13. Self-rated change in caregiver burden was measured retrospectively with a single question item. Binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden during the pandemic, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted for all variables.Participants' mean age was 52.3 years (standard deviation 15.9), 48.8% of participants were male, 56.7% reported increased caregiver burden, and 19.3% exhibited SPD. Increased caregiver burden was significantly associated with SPD (adjusted odds ratio: 1.90; 95% confidence interval: 1.37-2.66). The association between increased caregiver burden and SPD was stronger among caregivers who were married, those undergoing disease treatment, and those with a care-receiver with a care need level of 1-2.The results revealed that more than half of caregivers reported increased caregiver burden, and increased caregiver burden was associated with SPD during the pandemic. Measures supporting mental health for caregivers with increased caregiver burden should be implemented immediately.

BackgroundLittle is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data.MethodsThis prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan.ResultsIn total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants’ mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status.ConclusionsLiving in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.

Objective: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. Methods: Participants were 3567 individuals aged &ge, 65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. Results: Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward, their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (&beta, = &minus, 0.39, 95% confidence interval: &minus, 0.72, &minus, 0.06). Conclusions: Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.

Background Several previous studies reported social participation may reduce the incident of dementia; therefore, the type of positions held in the organization may relate to dementia onset. However, this hypothesis remains largely unknown. The purpose of the present study was to examine the additive effect of a leadership position in the organization on dementia onset and social participation among elderly people in a local community, according to data from a Japanese older adults cohort study. Methods Of 29,374 community-dwelling elderly, a total of 15,313 subjects responded to the baseline survey and were followed-up from November 2003 to March 2013. To evaluate the association between dementia onset and social participation as well as the role in the organization, we conducted Cox proportional hazard regression analysis with multiple imputation by age group (aged 75 years older or younger). The dependent variable was dementia onset, which was obtained from long-term care insurance data in Japan; independent variables were social participation and the role in the organization to which they belonged (head, manager, or treasurer). Covariates were sex, age, educational level, marriage status, job status, residence status, alcohol consumption, smoking status, and walking time, instrumental activities of daily living, depression, and medical history. Results During the follow-up period, 708 young-old elderly people (7.7%) and 1289 old-old elderly people (27.9%) developed dementia. In young-old elderly, relative to social non-participants, adjusted Hazard Ratio (HR) for dementia onset for participants (regular members + leadership positions) was 0.75 (95% confidence interval (CI), 0.64–0.88). Relative to regular members, adjusted HR for dementia onset for non-participants was 1.22 (95% CI, 1.02–1.46), for leadership positions 0.81 (95% CI, 0.65–0.99). The results for old-old elderly participants did not show that any significantly adjusted HR between dementia onset and social participation, the role in the organization. Conclusions In young-old elderly people, social participation might have a positive effect on dementia onset, and holding leadership positions in organization could lead to a decrease in risk of dementia onset by almost 20% than regular members. Electronic supplementary material The online version of this article (10.1186/s12877-017-0688-9) contains supplementary material, which is available to authorized users.

BackgroundSocial relationships consist of mutually related but distinct dimensions. It remains unclear how these domains independently contribute to incident dementia. This large-scale, prospective cohort study examines associations between the social relationship domains as well as their combinations and incident dementia among community-dwelling older adults.MethodsWe analysed data from 13 984 community-dwelling adults aged 65+ without long-term care needs living in Aichi prefecture in Japan. Incident dementia was assessed based on the Long-term Care Insurance records, followed for 3436 days from the baseline survey conducted in 2003. Three social relationships domains (social support, social networks and social activities) were further divided into a total of eight subdomains. A social relationship diversity score was calculated using the social relationship domains which were significantly related to incident dementia.ResultsA Cox proportional hazards model showed that being married, exchanging support with family members, having contact with friends, participating in community groups and engaging in paid work were related to a lower likelihood of developing incident dementia, controlling for covariates and other social relationship domains. The diversity scores, ranging from 0 to 5, were linearly associated with incident dementia (pConclusionsOur findings revealed five social relationship subdomains which were negatively related to incident dementia, suggesting that dementia may potentially be prevented by enhancing these social relationships. Future studies should examine independent pathways between each social relationship domain and incident dementia.

ObjectiveIn the 2011 Great East Japan Earthquake, as in Hurricanes Katrina and Rita in the United States, older individuals were at the greatest risk of mortality. Much concern has been raised about developing plans to reduce these risks, but little information has been provided about preparedness, and the key role played by caregivers has been largely unexplored. The aims of this study were thus to examine the preparedness of family caregivers of older adults with long-term care needs and to identify the characteristics of older adults and their caregivers that are associated with poor preparedness and greater concern about disasters.MethodsShortly after the Great East Japan Earthquake, the second wave of the Fukui Longitudinal Caregiver Study was administered to the family caregivers of older Japanese individuals with long-term care needs. The sample included 952 caregivers from 17 municipalities in Fukui prefecture. Logistic regression analyses were used to identify the factors associated with self-assessed preparedness, evacuation planning, and caregivers’ concerns about preparedness.ResultsThe majority (75%) of the caregivers had no concrete plans for evacuation in an emergency, and those caring for persons with dementia were 36% less likely to have any plan. In multivariate models, caregivers who were more experienced and wealthier and who reported more family and community support were more likely to feel well prepared. Caregivers with poor health or limited financial resources or who were responsible for older persons with mobility difficulties reported higher levels of anxiety about their disaster preparedness.ConclusionsThis study indicates that most caregivers are ill prepared to respond in emergencies and that caregiver resources, community support, and the needs of older care recipients influence both preparedness and concern about disasters. Education for caregivers and the development of community support programs could provide important sources of assistance to this vulnerable group. (Disaster Med Public Health Preparedness. 2017;11:31–38)

Subjective well-being (SWB) of older adults could be affected by both individual and community characteristics. However, the effect of community characteristics, such as population aging in local areas, remains unclear. This study examined the cross-sectional and longitudinal associations between the area-level population aging and SWB of older individuals from two distinct surveys. Those analyzed were 572 respondents aged 75 years and older for a cross-sectional survey in a metropolitan area in Tokyo, Japan (Study 1) and 1,257 and 859 respondents for a cross-sectional and longitudinal analysis, respectively, for a 2-year longitudinal survey project in urban and rural areas of Fukui Prefecture (Study 2). Area-level population aging was assessed by the number of people aged 65 years or older per 100 residents. SWB was assessed with the Life Satisfaction Index-A (LSIA). Multilevel analysis was performed to examine unconditional and conditional associations between the area-level number of older adults per 100 residents and the individual-level LSIA scores. The area-level number of older adults per 100 residents was significantly and positively associated with the LSIA scores in Study 1 (p = 0.042), even after controlling for the area- and individual-level covariates. In Study 2, we also found a significant effect of the area-level number of older adults per 100 residents on LSIA scores in the longitudinal multivariate analysis (p = 0.049). Findings from two survey projects suggested cross-validity in the positive effect of area-level population aging on older adults' SWB. Policymakers should consider older citizens' SWB in the recent urban-to-rural migration governmental policy as well as in urban renovation planning.

Safer and more effective programs are required to cope with an increasing number of older people with depression. Hence, we developed the Positive Photo Appreciation (PPA) program. A three-month pilot randomized controlled trial was conducted with healthy Japanese individuals aged 65&ndash, 84 years, assigned to a PPA group (n = 28) or Photo Correspondence Education (PCE) (control group) (n = 27). We used the Center for Epidemiologic Studies Depression Scale (CES-D) score as the primary outcome measure. Secondary outcome measures, among others, were cognitive function and positive emotion. Data collected at baseline and post-intervention were analyzed using a linear mixed-effect model. Over 80% of the participants in the PPA group completed and were satisfied with the program. Compared with the PCE group, the CES-D score in the PPA group significantly improved (main effect of group: t = &minus, 4.30, p &lt, 0.001, interaction effect of group by time: t = 4.39, p &lt, 0.001), with an effect size of d = 1.23. Additionally, a positive significant interaction effect of group by time was found in the Positive and Negative Affect Schedule (t = &minus, 2.33, p = 0.024). The PPA program might be promising for mitigating depressive mood in older adults.

Aim Long-term care systems may alleviate caregiver burdens, particularly for those with fewer resources. However, it remains unclear whether socioeconomic disparity in caregiver burdens exists under a public, universal long-term care insurance (LTCI) system. This study examined income-based inequalities in caregiving time and depressive symptoms in Japanese older family caregivers. We further compared inequality in depressive symptoms with that of non-caregivers to evaluate whether family caregiving exacerbates this disparity. Methods Data were obtained from a cross-sectional, nationwide survey conducted by the Japan Gerontological Evaluation Study in 2013. Participants were functionally independent older adults aged ≥65 years (N = 21,584). Depressive symptoms were assessed using the Geriatrics Depression Scale (GDS); caregiving hours per week, household income, and other covariates were also assessed. Results Family caregivers occupied 8.3% of the total. A Poisson regression model revealed that caregivers in lower income groups (compared to those in the highest) were 1.32 to 1.95 and 1.63 to 2.68 times more likely to engage in ≥36 and ≥72 hours/week of caregiving, respectively. As for the GDS (≥5), an excess risk was found in the caregivers in lower (compared to higher) income groups (adjusted prevalence ratio: 1.57-3.10). However, an interaction effect of income by caregiving role indicated no significant difference in inequality between caregivers and non-caregivers (p = .603). The excess risk for GDS (≥5) in the caregivers compared to non-caregivers was observed across income groups. Conclusions Our findings revealed a possible disparity in family caregivers under the public LTCI system. Further studies should examine factors associated with longer caregiving hours in lower income households. Our findings also suggest the necessity for more efforts to alleviate depressive symptoms in family caregivers under the LTCI system regardless of income level, rather than exclusively supporting those with a low income.

Aims The present study examined the impact of serious spousal illness or hospitalization on community-dwelling older adults' self-rated health (SRH), and explored the moderating effects of sex and residential proximity to adult children using a prospective and representative survey design. Methods The sample was obtained from a 2-year longitudinal survey of non-institutionalized men and women aged 65 years and older carried out in the Fukui Prefecture, Japan (n = 1573). The effect of serious spousal illness or hospitalization on SRH during the survey period was examined after controlling for baseline SRH, sex, age, socioeconomic status, chronic illness and other baseline covariates. Results Overall, 15.7% of respondents had experienced a serious spousal illness or hospitalization within the previous year. After controlling for covariates, spousal illness had a significant negative effect on SRH at follow-up (P = 0.031). More serious effects of spousal illness were found in older adults whose children lived farther than 30 min away than in couples who lived with their children (P = 0.009). However, there was no significant interaction effect between sex and spousal illness. Conclusions Serious spousal illness could cause deterioration in the health of older spouses, particularly for older parents whose children live a distance away. Geriatr Gerontol Int 2015; ●●: ●●–●●.

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents’ mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.

In Asian nations, family ties are considered important. However, it is not clear what happens among older people with no such ties. To investigate the association, we used longitudinal data from the Aichi Gerontological Evaluation Study (AGES) project. Functionally independent older people at baseline (N = 14,088) in 10 municipalities were followed from 2003 to 2013. Social ties were assessed by asking about their social support exchange with family, relatives, friends, or neighbors. Cox proportional hazard models were employed to investigate the association between social ties and the onset of functional disability adjusting for age, health status, and living arrangement. We found that social ties with co-residing family members, and those with friends or neighbors, independently protected functional health with hazard ratios of 0.81 and 0.85 among men. Among women, ties with friend or neighbors had a stronger effect on health compared to their male counterparts with a hazard ratio of 0.89. The fact that social ties with friends or neighbors are associated with a lower risk of functional decline, independent of family support, serves to underscore the importance of promoting social ties, especially among those lacking family ties.

Prevalence of depressive symptoms is lower in communities with greater social capital (SC). However, it is unclear whether a prevalence of depressive symptoms will decrease in communities where SC has increased. We investigated the relationship between the changes in municipality-level SC and depressive symptoms by using 5-year repeated cross-sectional data from the Japan Gerontological Evaluation Study. In 2010 and 2016, self-reported questionnaires were mailed to functionally independent residents aged 65 years or older living in 44 municipalities, valid responses were received from 72,718 and 84,211 people in 2010 and 2016, respectively. All scores were aggregated at the municipality level. The dependent variable was the change in the prevalence of depressive symptoms that were diagnosed with a 15-item Geriatric Depression Scale. Independent variables were the score of change in health-related SC indicators, e.g., social participation, social cohesion, and reciprocity. A multiple regression analysis was employed. The average prevalence of depressive symptoms decreased from 28.6% in 2010 to 21.3% in 2016. The increases in the percentages of sports group participation (B, &minus, 0.356), and reciprocity scores (B, &minus, 0.597) were significantly associated with the decrease in the prevalence of depressive symptoms after adjusting for potential confounding variables. Our findings suggest that community SC might be an intervention for protecting depressive symptoms in municipalities.