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This cross-sectional study aimed to investigate the associations between salivary testosterone concentrations and cognitive function in 70-year-old Japanese elderly people without dementia and stroke.Participants were 197 Japanese community-dwelling people aged 69-71 years. Their salivary samples were collected, and their cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Participants were also administered a 10-item recall and a 24-item recognition test. The data for 179 (106 men and 73 women) individuals were analyzed, excluding individuals with a past history of stroke and dementia. Multivariate logistic regression analyses were performed after adjusting for lifestyle factors and analyzing data separately for men and women.MoCA-J scores showed that men with low testosterone concentrations had a significantly greater risk of low cognitive performance than those with high testosterone concentrations (adjusted odds ratio: 4.72, 95% confidence interval: 1.06-21.00), while no significant association was found in women. The 10-item recall test scores showed that higher testosterone concentrations were significantly associated with greater recall in the second trial in women (standardized beta = 0.24, P = 0.040), whereas no significant association was found in men. Salivary testosterone concentrations were positively associated with better cognitive performance in older men and women.The associations between salivary testosterone concentrations and cognitive function were shown by different tasks for men and women. Geriatr Gerontol Int 2022; 22: 1040-1046.

Good health and positive social relationships are significant resources in well-being. However, little is known about how intrapersonal changes and interpersonal differences in health and social relationships are associated with well-being in later life. This study aimed to examine within- and between-person effects of physical health and social relationships with family, friends, and neighbors (social support and companionship) on well-being. We analyzed longitudinal data from a representative sample of older Japanese adults aged 74 to 86 years (N=1388). The results from multilevel models showed that decline in health (intrapersonal changes) was associated with lower well-being. Nevertheless, there was the interaction effect of social relationships with family and neighbors (between-person differences) in the relationship between health and well-being change. Among participants with lower social support from family and neighbors, the negative association between decline of health and well-being was stronger. Conversely, participants with higher social support reported higher well-being regardless of physical health change. Contrastingly, among participants with higher companionship with family and neighbors, participants reported higher well-being at the time of maintaining or increasing physical health. For participants with lower companionship, health change was not associated with well-being. These findings suggest social support has a preventive effect on well-being in the face of declining health, while companionship has a facilitative impact on well-being in good health. The results also suggest relationships with neighbors as well as family play an important role in well-being in very late life.

Background Concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with locally advanced non–small-cell lung cell cancer (LA-NSCLC). We conducted a phase I/II study of biweekly carboplatin and nab-paclitaxel (nab-PTX) with radiotherapy (RT). Materials and Methods In the phase I part, patients with inoperable stage IIIA/IIIB NSCLC were treated with carboplatin (area under the time-concentration curve, 4) and nab-PTX (60-100 mg/m2) on days 1, 15, and 29. Thoracic RT was administered from day 1 to a total dose of 60 Gy in 30 fractions. In the phase II part, patients were administered carboplatin and nab-PTX on days 1, 15, and 29 at the recommended dose (RD). The primary endpoint of the phase I part was to determine the maximum tolerated dose and the RD. In the phase II part, the primary endpoint was 2-year overall survival (OS) rate, and secondary endpoints were the objective response rate, progression-free survival, OS, and safety profile. Results In the phase I part, although maximum tolerated dose was not obtained, the RD was carboplatin (area under the time-concentration curve, 4) and nab-PTX (100 mg/m2). Of the evaluable 28 patients, the rate of 2-year OS was 67.8% (95% confidence interval, 49.3%-82.1%). The objective response rate was 96.4%, and the median follow-up time was 33.2 months. The median progression-free survival was 18.2 months (95% confidence interval, 13.1 months to not reached). The most common toxicities of grade 3 or higher were neutropenia (60.5%), anemia (14.2%), thrombocytopenia (7.2%), and pneumonitis (3.6%). Conclusions This study achieved the primary endpoint. Biweekly carboplatin and nab-PTX with concurrent RT was well-tolerated and exerted promising antitumor activity.

Abstract. The Montreal Cognitive Assessment (MoCA) is a test assessing global cognition in older adults which is often used by researchers and clinicians worldwide, although some of its psychometric properties have yet to be established. We focus on three fundamental aspects: the factorial structure of the MoCA, its general factor saturation, and the measurement invariance of the test. We administered the MoCA to a large sample of Japanese older adults clustered in three cohorts (69–71-year-olds, 79–81-year-olds, and 89–91-year-olds; N = 2,408). Our results show that the test has an overall stable hierarchical factorial structure with a general factor at its apex and satisfactory general-factor saturation. We also found measurement invariance across participants of different ages, educational levels, economic status, and sex. This comprehensive investigation thus supports the idea that the MoCA is a valid tool to assess global cognition in older adults of different socioeconomic status and age ranges.

Nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis (IPF). In addition, in EU countries, nintedanib plus docetaxel is used for patients with advanced non-small cell lung cancer (NSCLC) after first-line chemotherapy. Here, we report a case of advanced NSCLC in a patient with IPF successfully treated with nintedanib monotherapy. A 69-year-old man was diagnosed with NSCLC complicated by IPF. After three lines of chemotherapy, he still had progressive disease. Because his IPF had also progressed, requiring supplemental oxygen, we decided to start best supportive care and introduced nintedanib to treat his IPF. One month later, we observed a partial remission of the primary tumor and pleural disseminations without severe adverse events. Nintedanib monotherapy might therefore be an effective therapeutic choice for NSCLC in patients with IPF who are unable to tolerate cytotoxic chemotherapy. KEY POINTS: Efficacy of nintedanib administered in a NSCLC patient with IPF. Nintedanib monotherapy might be a therapeutic option for NSCLC patients with IPF who are unable to tolerate chemotherapy.

Background Adjuvant chemotherapy with platinum‐based regimens for completely resected early‐stage non‐small cell lung cancer (NSCLC) provides overall survival benefit in several clinical trials. Objectives We conducted this prospective study to evaluate the efficacy and safety of adjuvant chemotherapy with carboplatin and S‐1 for patients with completely resected stage II to IIIA NSCLC. Methods Patients with completely resected stage IIA to IIIA NSCLC were treated with four cycles of carboplatin with area under the concentration time curve of 5 mg/mL/min on day 1 plus S‐1 at 80–120 mg/bodyweight per day for two weeks, followed by one‐week rest as adjuvant chemotherapy. The primary endpoint was the completion rate of three cycles of the treatment. The secondary endpoints were safety and two‐year survival rate. Results A total of 19 patients were enrolled, until the study was terminated prematurely because of fatal pulmonary embolism in two patients. The median number of treatment cycles was three (range: 1–4). The completion rate of three cycles was 78.9% (95% confidence interval [CI]: 56.6–91.4%). Two‐year disease‐free survival rate was 57.8%. Grade 3 or 4 hematological toxicities included neutropenia (26.2%), anemia (5.2%), and thrombocytopenia (15.7%). Grade 3 or 4 nonhematological toxicities were anorexia (10.5%) and nausea (10.5%). Febrile neutropenia developed in 5.2%. In two patients (10.5%), grade five pulmonary embolism was observed, and the causal relationship with treatment could not be denied. Conclusions Carboplatin and oral S‐1 had modest survival benefit, but this regimen was not tolerable in an adjuvant setting because fatal pulmonary embolism occurred in two patients. Key points Carboplatin and oral S‐1 had modest survival benefit but this regimen was not tolerable. Fatal pulmonary embolism occurred in this regimen.

The purpose of this study was to examine the protective effect of trait resilience, a positive personality characteristic that enhances individual adaptation to life events and adversity, in the face of declining social relationships in later life. Social relations have a significant effect on our development and well-being throughout life. However, it is known that a decline in physical, cognitive, and mental functioning makes it difficult to maintain active participation in society and leads to shrinking social networks in later life. Therefore, it is important to identify protective factors that enable people to maintain positive social relations when functioning in daily life declines in old age. We analyzed longitudinal survey data from a representative sample of older Japanese adults aged 74 to 86 years (N=1064). The interaction effect of resilience in the relationship between functions (physical, cognitive, and mental) and relationships with friends (social support exchange and companionship) was examined using multi-group Structured Equation Modeling (SEM). Respondents were divided into upper quartile and lower quartile groups according to their Resilience Scale (RS-14) scores. The results showed significant group differences for the effect of cognitive function on friendship. The positive correlation between cognitive functioning and friendship was stronger among respondents with low resilience. For high resilience participants, cognitive functioning was not associated with friendship. The results suggest that resilient older adults cope well with poor cognitive health and maintain positive social relationships in very late life.

Objectives:Centenarians have survived into very late life, but whether they reach very old age in good health remains unclear. The purpose of this study was to compare the cardiovascular health status and cognitive functioning of centenarians in the United States with centenarians in Japan.Design, Setting, and Participants:This cross-national design compared centenarians from the United States and Japan. The sample of U.S. centenarians was recruited from the Georgia Centenarian Study and included 287 centenarians. The sample of Japanese centenarians was recruited from the Tokyo Centenarian Study and included 304 centenarians.Measurements:Cognitive functioning was assessed with a mental status questionnaire, and cardiovascular disease by a health history assessment, blood pressure, and selected blood parameters.Results:The results suggest that Tokyo centenarians had lower disease experiences and BMI values, when compared to Georgia centenarians, but blood pressure was higher among Japanese centenarians. Lower levels of hemoglobin in Japanese centenarians and higher levels of C-reactive protein in Georgia were also found. The positive association of hypertension and albumin levels with cognitive functioning and the negative association of stroke occurrence with cognitive functioning were replicated in both countries. Differential effects were obtained for heart problems, BMI, and C-reactive protein (with positive effects for Tokyo centenarians, except for C-reactive protein).Conclusion:For extremely old individuals, some markers of cardiovascular disease are replicable across countries, whereas differential effects for cardiovascular health also need to be considered in cardiovascular health.

Pembrolizumab has become the standard first-line treatment for non-small cell lung cancer (NSCLC) patients with high PD-L1expression. MET exon 14 skipping is a rare mutation typically found in older, female, and non-smoking patients with NSCLC. Herein, we report the case of a 71-year-old non-smoking woman who was diagnosed with NSCLC in the left lung. EGFR mutation and ALK fusion were not detected. Because the biopsy specimen showed high PD-L1 expression with a tumor proportion score of 95%, pembrolizumab was introduced as first-line therapy, but resulted in no clinical benefit. The patient was subsequently administered chemotherapy with carboplatin and pemetrexed, leading to remarkable tumor shrinkage. A next-generation sequencing panel analysis revealed a MET exon 14 skipping mutation. Thus, pembrolizumab might not be effective for NSCLC patients with MET exon 14 skipping mutations, even if PD-L1 expression is high.

This study explored the associations between personality traits and cognitive failure (including minor lapses and prospective and retrospective memory failure) among middle-aged and older adults living in Japan. The participants were 373 adults, aged 40–84 (167 men and 206 women). The 15-item Japanese version of the Short Inventory of Minor Lapses was used to evaluate minor lapses, and the 16-item Japanese version of the Prospective and Retrospective Memory Questionnaire was used to assess prospective and retrospective memory failure. The participants’ variables evaluated for their association with cognitive failure were gender, age, education, paid work, social network, chronic disease, sleep quality, and the Big Five personality traits (i.e., neuroticism, extraversion, openness, agreeableness, and conscientiousness). Multivariable regression analyses demonstrated that sleep quality (β = −0.232), neuroticism (β = 0.163), and conscientiousness (β = −0.295) were related to minor lapses; age (β = 0.152), sleep quality (β = −0.168), and conscientiousness (β = −0.290) were associated with prospective memory failure; and age (β = 0.268), sleep quality (β = −0.146), and conscientiousness (β = −0.221) were associated with retrospective memory failure. These findings may facilitate the development of efficient strategies for the prevention of cognitive dysfunction and its adverse consequences for personal health.

Aim As living alone is associated with poor mental health, seeking a moderating factor in this relationship may help enhance quality of life of older people living alone. Therefore, this study examined the moderating effect of leisure activity on the relationship between living alone and mental health in older people. Methods This study employed a cross-sectional analysis of questionnaire data. Research was conducted in a metropolitan Tokyo ward from September to October 2017. Participants were 314 community-dwelling Japanese individuals (158 women, 156 men) aged 70-84 years (mean ± SD, 77.7 ± 4.4). We analyzed mental health using the Japanese version of the World Health Organization-Five Well-Being Index as the outcome variable, and the 11 items of the Leisure Activity Scale and living arrangements as explanatory variables. Multivariate analyses were used to examine effects of leisure activity on living arrangements and mental health. Results The proportion of people living alone was 22.9% (N = 72), and the mental health score was mean ± SD, 14.2 ± 7.2. Multiple regression analysis showed that subjective economic status (β = -0.177), instrumental activities of daily living (β = 0.167), living arrangements (β = -0.142) and leisure activity (β = 0.481) were associated with mental health. The interaction effect between living arrangements and leisure activity on mental health was significant (β = 0.112). Conclusions Our findings show that leisure activity moderates poor mental health in older adults living alone. Accordingly, interventions should encourage older adults living alone to engage in leisure activity to improve their mental health. Geriatr Gerontol Int 2021; 21: 421-425.

Objective Procalcitonin (PCT) has received much attention as a serum marker for bacterial infection. Elevated serum PCT is occasionally seen in severe trauma, heatstroke, and neoplastic diseases, including lung cancer with neuroendocrine component. Results In the present study, we evaluated PCT expression in the specimen of pulmonary neuroendocrine tumors, comparing large cell neuroendocrine carcinoma (LCNEC), carcinoid, and small cell lung carcinoma (SCLC). Pathological specimens of 10 LCNEC, 4 carcinoid, and 7 SCLC cases were evaluated with immunochemical staining of PCT. Clinical characteristics and serum levels of PCT and C-reactive protein were also evaluated. We observed positive PCT expression in 5 (50%) LCNEC and 2 (50%) carcinoid specimens that were surgically resected. Whereas serum PCT levels were not elevated in patients with PCT-positive carcinoid, two out of three LCNEC patients with high PCT expression in the tumor had elevated serum PCT levels that reflected disease progression. In patients with SCLC, PCT was not detected in the tumor or serum. This is the first immunohistochemical study of the PCT expression in the lung tumor specimens. We concluded that, in patients with LCNEC, high serum PCT levels may be indicative of disease activity and serve as a biomarker.

This chapter describes the data sources that are available for verifying the ages of the oldest-old in Japan. These sources can be both official and non-official documents. The official documents consist primarily of education and employment records issued by administration offices. The non-official documents include the testimonies of the centenarians themselves, their relatives, and their care workers; as well as media reports. We collected information from these official and non-official sources in order to confirm that three Japanese individuals who had reportedly survived to age 115 were indeed that old. The first of these individuals is Mr. Jiroemon Kimura (J.K.), who spent most of his life in his birth place. In his case, we were able to gather information from various sources, including from official and non-official documents. But for the other two individuals, Mrs. Misao Okawa (M.O.) and Mrs. Chiyo Miyako (C.M.), who relocated several times within urban areas, we were able to collect only a limited amount of information. In particular, we were unable to find many official documents about their original family members. These three cases suggest that the availability of the data needed to verify the ages of individuals who were born around 1900 might differ depending on the following three conditions: whether the person has moved from his/her place of birth, whether the person has been living in rural or urban areas, and whether the person is male or female.

A 68‐year‐old male patient with squamous cell carcinoma (cT4N2M0) of the left upper lobe received chemoradiotherapy followed by durvalumab, an immune checkpoint inhibitor. The tumour responded well to the therapy, but an infiltrative shadow appeared in the left upper lobe, which was outside the radiation field. Despite treatment with corticosteroid and antibiotics, the development of a cavitary lesion was noted. As Aspergillus fumigatus was isolated from the bronchoscopy specimen, antifungal agents were also administered, but the cavitary lesion further developed. Because his general condition worsened and the entire left lung was destroyed, the patient underwent a left pneumonectomy and recovered without recurrence. The pathology of the removed lung revealed a scarred nodule with granulation tissue around and a cavernous lesion having a necrotic substance inside. We considered that durvalumab might further accelerate the inflammatory response, which had been introduced by fungal infection, leading to uncontrollable inflammation of the lung., This report has presented a case of destroyed lung in a patient with non‐small cell lung cancer (NSCLC) who received chemoradiotherapy followed by durvalumab. Because of the sustained inflammation and abolished function of the left lung, left pneumonectomy was required. We considered that durvalumab might further accelerate the inflammatory response, which had been introduced by fungal infection, leading to uncontrollable inflammation of the lung.

Mental rotation is a spatial ability allowing one to represent and rotate an object in one’s mind, and its performance declines with age. Given previous findings indicating that likening a to-be-rotated object to a human body improves mental rotation performance in young adults, we examined whether this human-body analogy would improve older adults’ mental rotation performance. We also tested whether the human-body analogy effect is age-dependent. In the present study, we analyzed data from 423 community-dwelling older adults (age range: 86–97 years; 219 men and 204 women) who answered two items of a paper-and-pencil mental rotation test: one on abstract cube objects (control condition) and one on cube objects with a human face (embodied condition). The results revealed that more participants correctly answered the item in the embodied condition (32.2%) compared to that in the control condition (19.6%), indicating that the human-body analogy is effective in an oldest-old population (i.e., people aged over 85 years). Notably, we found age differences in human-body analogy effects. While accuracy for mental rotation of abstract objects declined with age, accuracy for embodied objects was preserved with age. These findings suggest that the human-body analogy may prompt older adults to adopt a holistic, rather than a piecemeal, rotation strategy.

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

Evidence indicates that older adults experience high levels of emotional well-being. However, little is known empirically about the underlying mechanism of this state. The purpose of the present study was to investigate whether emotion regulation mediates the link between age and affect in adulthood. The sample consisted of 516 Japanese participants aged 30 (±1), 50 (±1), and 70 (±1) years, who were registered with an Internet survey company. Cognitive reappraisal and expressive suppression were measured as emotion regulation strategies. Positive and negative affect were assessed. Older participants reported lower negative affect than younger participants, while positive affect was not correlated with age. Cognitive reappraisal partially mediated the relationship between age and affect, whereas expressive suppression did not. The results suggested that age-related increase in cognitive reappraisal could contribute to improvements in affect, but that another adaptive form of emotion regulation may mediate the relationship between age and affect. Our study thus indicates that developments in emotion regulation could explain the mechanism of stable everyday affect throughout adulthood, and that researchers should further explore another form of adaptive emotion regulation.

Afatinib, a second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) for mutant non-small cell lung cancer (NSCLC), was approved in Japan in 2014. This study evaluated clinical outcomes of afatinib in real-world practice. Medical records of patients who received afatinib for advanced EGFR-mutant NSCLC were retrospectively reviewed. In total, 128 patients were analyzed. Seventy-six patients received afatinib as the first-line setting and 52 as the re-challenge setting (i.e., after failure of prior first-generation TKI). There was no difference in patient characteristics, such as age, sex, and PS, between the first-line and the re-challenge settings. In the first-line setting, the median progression-free survival (PFS) was 17.8 months (95% confidence interval [CI] 13.7-21.5 months). The overall survival (OS) was 39.5 months (95% CI 34.4- not reached). The response rate (RR) was 64.4%. Subset analysis indicated that patients with dose reduction showed longer PFS than those without dose reduction (18.5 months versus 7.9 months) (P = 0.016). In the re-challenge setting, the median PFS was 8.0 months (95% CI 4.9-9.5 months). The RR was 25%. Most common adverse events leading to dose modification or treatment discontinuation included diarrhea, paronychia, and oral mucositis in both settings. Interstitial lung disease occurred in 5.4% (7/128). In the real-world practice in Japan, afatinib showed comparable or better efficacy compared with that shown in previous clinical trials in both the first-line and the re-challenge settings.

The present retrospective study was conducted to evaluate the efficacy of immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC) harboring driver mutations. Patients with NSCLC harboring driver mutations who received ICIs (nivolumab or pembrolizumab) were reviewed in Hirosaki University and Aomori Prefectural Central Hospital. There were 139 patients who received molecular targeted drugs, including 24 patients treated with ICIs. Patient characteristics were as follows: Male/female, 5/19; median age 68 (range 39–82); smoking/non-smoking, 6/18; PS 0–1/2, 20/4; driver mutation status, EGFR/ALK/RET/ROS1: 21/1/1/1. The overall response rate was 16.7% [95% confidence interval (CI), 7.0–37.1%] and the disease control rate was 33.4% (95% CI, 18.9–55.1%). The median progression-free survival (PFS) time was 62 days (95% CI 52–81 days). In the patients who had been treated by the preceding tyrosine kinase inhibitor (TKI) for >1 year, the PFS time was 110 days. On the other hand, in the patients who had received a TKI for less than a year, the PFS time was 56 days, which was significantly shorter (P=0.012). To conclude, some of the patients with NSCLC harboring driver mutation could benefit from ICIs, and the duration of previous TKI treatment may be associated with the efficacy.

The previous studies repeatedly reported that the physical and social environments were related to subjective well-being in older adults. Do environments relate to maintain cognitive functions in older adults directly and/or indirectly? To maintain good cognitive abilities is important to ageing well. The purpose of this study is to investigate the relationships between cognitive functions and the physical and social environments in older adults after age 75. We used data from locally representative longitudinal study of older adults aged 75 ± 1, 80 ± 1, 85 ± 1 conducted in Japan (The Keio-Kawasaki Aging Study; N = 1388). We assessed the physical and social environments (age-friendly communities), social engagement (social activity participation), sense of communities (membership, attachment, and cohesion), and cognitive abilities. Covariance structure analysis showed that after controlling age and an educational factor, which were related to cognitive functions, social activity participation played a significant role to contribute to maintain cognitive functions directly, and that better physical and social environments took a facilitating role to increase frequencies of social activity participation through higher sense of community (membership and attachment). The previous studies reported that age-friendly cities and communities were related to subjective well-being in older adults. Results suggested that better physical and social environments had an important role to maintain cognitive function as well as well-being in older adults through sense of community and social engagement.

Background: It is pointed out that the growth of gerotranscendence, which is a change from material and rational values to irrational and transcendental values in old age, is encouraged by a crisis experience. Caregiving experience is a critical one that older people have a tendency to experience, and it is considered to promote the growth of gerotranscendence. Objective: This study examines whether caregiving experience promotes the development of gerotranscendence of Japanese adults aged 70 years. Methods: Participants were 1000 community-dwelling older adults (mean age = 70.1 years; 479 men, 521 women). Two follow-up surveys were conducted at three-year intervals from the baseline survey in 2010. Gerotranscendence was measured for each survey using the Japanese Gerotranscendence Scale Revised. We asked whether having or not having caregiving experience at the baseline. Results: Longitudinal changes in gerotranscendence at three points were analyzed using the conditional growth curve model. Gender and caregiving experience were included as explanatory variables. The results indicated that the intercept at three points was significant. Gender had a significant effect only on the intercept of gerotranscendence at three points. The degrees of gerotranscendence in women were higher than in men at the baseline. Caregiving experience had a significant positive effect on intercept and slope of gerotranscendence. Conclusions: This study revealed that caregiving experience has an accelerating effect on the growth of gerotranscendence of older adults. Our results suggest that life crisis as well as becoming receptive as a growth-related change that occur during caregiving could increase the degrees of gerotranscendence.

Background: The INPULSIS trials revealed that nintedanib reduced the decline in lung function in patients with idiopathic pulmonary fibrosis. We aimed to evaluate the efficacy and safety of nintedanib in Japanese idiopathic pulmonary fibrosis patients in real-world settings. Method: Medical records of idiopathic pulmonary fibrosis patients, who received treatment with nintedanib in five institutions between July 2015 and June 2017, were reviewed. Patients with % forced vital capacity ⩾50% and % predicted diffusing capacity of the lung carbon monoxide ⩾30% were classified as the moderate group and those with more impaired lung functions as the severe group. Result: Among 158 patients analyzed, 132 (84.6%) were classified as the moderate group and 26 (15.4%) as the severe group. In the moderate group, changes in forced vital capacity in 12 months were significantly different between before and after nintedanib administration (−253 ± 163 vs −125 ± 235 mL; p = 0.0027). In contrast, changes in forced vital capacity in 12 months were not significantly changed by nintedanib treatment in the severe group (−353 ± 250 vs −112 ± 341 mL; p = 0.2374). Incidence of acute exacerbation was higher in the severe group than in the moderate group (30.8% vs 18.9%). The overall survival of the moderate and the severe groups was 17.2 and 10.1 months. Conclusion: In real-world practice, nintedanib showed comparable efficacy to those observed in previous trials. In the severe group, the efficacy of nintedanib might be limited.

Existing research has found effects of neighborhood environment on well-being. However, it is still not clear what features of neighborhood environments affect well-being for older adults and whether the impact of the environment varies depending on the health and economic conditions. In this study, we examined the relations between 4 physical and social neighborhood-context factors, that is, the availability of neighborhood physical resources (e.g. community centers and libraries), the walkability and accessibility, the availability of social resources (e.g. culture and recreation programs, and social care services), and the social inclusion (e.g. participation in decision making, and positive social attitude toward older adults), and individual-level well-being. Moreover, we examined the health and economic disparities of effect of neighborhood environments on well-being. We used data from locally representative longitudinal study of older Japanese aged 74 to 86 (N = 1388). Results from multi-level linear regression showed that after controlling individual variables having inhibitory/facilitatory effects of well-being, the availability of physical resources was associated with higher well-being score. Especially among older adults who had financial strains, the availability of physical environment had a positive effect on well-being more strongly. For older adults who had better physical functions, accessibility and walkability were associated with higher well-being score. The social inclusiveness was associated with higher well-being score among those who had no financial strain. These important findings demonstrate the need for more research exploring the underlying mechanisms. The potential benefits of this approach provide a basis for developing models of maintaining well-being for older adults.

Companionship with close others are known to have a significant positive effect on our well-being in later years of life. At the same time, it is known that the frequency of meeting and chatting with others, an indicator of companionship, declines as we age. In this study we explore the situation of companionship among older-old and oldest-old people. The focus of this study on understanding how the aging process affects the experience of companionship and how people adapt to the loss of companionship. Semi-structured, in-depth interviews with 43 people aged 75 and older living in urban communities in Kawasaki, Japan. Participants were asked about everyday interactions with close others and feelings they experienced at the time. Interviews were transcribed and analyzed qualitatively. Chatting, going out for lunch or dinner, and going shopping were examples of activities older Japanese enjoyed with close others. Almost all respondents mentioned the loss of their old friends and siblings. They also mentioned that the decline in their physical and cognitive health, as well as that of their companions hindered shared activities they used to enjoy. They cherished positive interactions with others, although the frequency declined. Some respondents intentionally made new companions in the physical proximity, but it was hard to compensate for the loss of old companions with new one. These findings suggest that the value of companionship remains or even increase as we age. It would be important to identify environmental or social factors that may prevent the loss of companionship among older adults.

Studies have reported that work exposure to cognitively demanding environments predicted the level of late-life cognitive abilities. To date, whether or not such a relationship between work complexity and cognitive function is maintained in very old adults remains unknown. In the present study, we examined how the associations between lifetime work’s complexity and global cognition vary by age groups (70s, 80s, and 90s). To this end, we used data from 2754 Japanese community-dwelling participants in the SONIC Project. Specifically, we tested multiple group path models comparing the models based on differences in age and gender. The effects of work complexities on global cognition were found for male septuagenarians and octogenarians, having controlled for the variables related to education. The relationships between them were marginally significant for male nonagenarians. Based on the analysis, we discuss the maintenance of cognitive reserve and implications for cognitive and physical health in very old ages.

Life environment across the life course—such as engagement in late-life leisure activity (LA), primary occupation, and early-life education—have been reported to be associated with better late-life cognitive outcomes. However, few studies have included all these factors from the past to the present due to the time-consuming procedure to measure all factors. This study examined (1) whether late-life LA is associated with better late-life cognition, after considering other life environments and (2) whether occupation, education, and childhood intelligence quotient have indirect effects on the late-life cognition through late-life LA. We used baseline data from the groups of 70- and 80-year-olds in the SONIC study (N = 1721 ). Global cognition was measured using the Montreal Cognitive Assessment. As for LA, participants were asked for yes/no answers to questions regarding their engagement in 158 activities. A latent factor representing LA was used in the analyses. We retrospectively evaluated the complexity of work with data, people, and things. As early-life environments, education and language and arithmetic abilities during elementary school were included in the analyses. Age and gender were controlled. A structural equation model showed that late-life LA was significantly associated with higher global cognition, even after controlling for all past factors (RMSEA = .050, GFI = .973, AGFI = .947). Sobel tests showed significant indirect effects of occupation, education, and childhood abilities on cognitive function. Results were robust across age and gender. It is suggested that engagement in LA explains individual differences in late-life cognitive function.