Biomedical subjects

Shoji Shinkai

Publications and source records attributed to Shoji Shinkai.

At least 19 recordsLinked to original sources

PubMed2006

Frequency of going outdoors as a good predictors for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan.

BACKGROUND: The clinico-epidemiologic relevance of the reduction in the frequency of going outdoors in older adults has not been well characterized. This study examined whether the frequency of going outdoors has predictive values for incident physical disability and recovery among community-dwelling elderly. METHODS: One thousand, two hundred and sixty-seven persons aged 65+ years who lived in a rural community in Niigata, Japan, and participated in the baseline survey were assessed again 2 years later in terms of mobility, and instrumental and basic activities of daily living (IADL and BADL). We compared the incident disability and recovery at follow-up among three subgroups classified by the baseline frequency of going outdoors: once a day or more often, once per 2-3 days, and once a week or less often. Multivariate analyses tested associations between the frequency of going outdoors and functional transition, independent of potential confounders. RESULTS: A lower frequency of going outdoors at baseline was associated with a greater incident disability, and a lower recovery at the two-year follow-up. Even after adjustment, the effects of going outdoors remained significant. Adjusted risks of incident mobility and IADL disabilities were significantly higher (odds ratio[OR]=4.02, 95% confidence interval [CI]: 1.77-9.14 and OR=2.65, 95% CI: 1.06-6.58), respectively, and recovery from mobility disability was significantly lower (OR=0.29, 95% CI: 0.08-0.99) for "once a week or less often" subgroup compared with "once a day or more often" subgroup. CONCLUSION: The frequency of going outdoors is a good predictor for incident physical disability and recovery among community-living elderly. Public health nurses and clinicians should pay more attention how often their senior clients usually go outdoors.

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PubMed2006

[Physical and psychological predictors for the onset of certification of long-term care insurance among older adults living independently in a community a 40-month follow-up study].

OBJECTIVE: To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community. METHODS: Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification. RESULTS: Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females. CONCLUSIONS: Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.

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PubMed2006

[Physical activity level and physical, mental and social factors in community-dwelling elderly people].

PURPOSE: This study was conducted to examine the relationship between physical activity level (PAL) and physical, mental and social factors in community-dwelling elderly people. METHODS: The subjects comprised 428 residents aged 70 or over living in Kusatsu-machi, Gunma, who took part in an interview and tests of physical fitness as part of the "NIKKORI-KENKOSODANJIGYO". Data for 330 out of the 428 residents were adopted for this study. The PAL was evaluated with a questionnaire developed by Naito et al. (2003). Subjects were interviewed on physical, mental and social functioning including the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence and cognitive function (Mini Mental State Examination: MMSE). Physical fitness tests included assessment of handgrip strength, usual and maximal walking speed, and one-leg standing balance with eyes open. RESULTS: Correlations between PAL and the TMIG Index of Competence, physical (e.g. physical fitness), mental (e.g. depression) and social (e.g. roles at home) factors, and smoking status were significant by ANCOVA adjusted for age and sex. Analysis using a general linear model indicated that smoking status, usual walking speed, depression, roles at home, frequency of going outdoors and visual impairment all together explained 13.5% of the PAL variance. CONCLUSION: The findings indicate that PAL in the community-dwelling elderly aged 70 years or over is associated with physical, mental and social factors.

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PubMed2006

[Longitudinal analysis of factors associated with participation in community-based mass screening for the frail elderly in need of care].

PURPOSE: To examine factors associated with participation in a community based comprehensive health check to screen frail elderly before they become in need of long-term care. METHODS: All residents aged 70 years and over living in Kusatsu, Gumma prefecture were surveyed for their sociodemographics, and physical, mental and social functioning through in-person interview in the years 2001 and 2003. In the following years--in 2002 and 2004, respectively--mass screenings were conducted to detect early signs of need for care among the elderly. Using the baseline interview information as explanatory variables, we performed multiple logistic regression analysis in order to examine the social determinants of participation in the mass-screening. RESULTS: For the first mass-screening, having high blood pressure and poor subjective health decreased the likelihood of attending the screening by 34% and 65% respectively. In contrast, one point increases in IADL, mobility and social-role score increased the probability of attendance by 27%, 26% and 26% respectively. After the screening was re-conducted, the factors influencing attendance appeared to have changed. With a third mass-screening, while the IADL and mobility score still had significant effects, elderly having excellent subjective health were less likely to go by some 48%. It was also found that not having visual impairment had a significantly positive effect on attendance. CONCLUSION: If local government conducts community-based mass screening aiming to screen the frail elderly in need of care, it is likely that there are high risk elderly among the non-participants. It is very important to follow up those non-participants using an attendance roll and provide appropriate advice. It is also worth discussing mass screening that focuses more on health promotion than on "screening" itself.

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PubMed2006

[An intergenerational health promotion program involving older adults in urban areas. "Research of Productivity by Intergenerational Sympathy (REPRINTS)": first-year experience and short-term effects].

OBJECTIVE: We have launched a new intervention study, called "Research of Productivity by Intergenerational Sympathy (REPRINTS)" in which senior volunteers engage in reading picture books to children. The "REPRINTS" program consistently involves social roles and intellectual activity, two higher-level functional capacities. This study reported findings and problems experienced through "REPRINTS" during the first year, ascertained potential effectiveness of social activity, and proposed methods for continued activity. METHODS: Basic concepts of "REPRINTS"program include "contribution to society", "life-long learning", and "group activity." Sixty seven volunteers and 74 controls, all aged 60 years and over living in three areas, ie., Chuo-ku, central Tokyo, Kawasaki city, suburb of Tokyo and Nagahama city, a local city, participated in a baseline health check-up in June, 2004. After completion of 3-month training seminars (once a week, 2 hr per session), volunteers visited public elementary schools and kindergartens in groups of 6-10 persons for 6 months. They were assessed again by follow-up health check-up in March, 2005. RESULTS: At baseline, the proportion of those who had no grand children (41.8% vs. 20.3%, P= 0.006), average school years (13.4 +/- 2.5 vs. 12.3 +/- 2.5 years, P= 0.008), having any experience of volunteer activities (79.1% vs. 52.7%, P=0.001), and an usual walking speed (86.7 +/- 12.3 vs. 81.3 +/- 12.9 m/min, P=0.012) were significantly higher in volunteers than in controls. There was no significant difference in other baseline characteristics between the two groups. At follow-up, social network scores for 56 volunteers were significantly improved: frequency of contact with grandchildren and others around neighborhood and size of circles of friends and acquaintances were increased, as compared to controls. Social support scores for the volunteers significantly decreased in the receiving aspect, while increased in the giving aspect. In addition, consciousness of loving community and self-rated health were significantly enhanced and hand-grip strength showed significantly less decline in volunteers than in controls. CONCLUSIONS: Through engaging in the intergenerational and intellectual volunteer programs for 9 months, subjective health, social support and network, consciousness of loving community and some aspects of physical performance were significantly promoted in senior volunteers. Coordination of existing administrative services enabled us to establish this "REPRINTS" health promotion program for community-dwelling older adults.

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PubMed2005

Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese.

This study examined whether cognitive impairment, falls, and urinary incontinence (UI) were independent predictors of functional decline using a 2-year observation of a non-disabled older Japanese cohort living in a community from 1999 to 2001. A total of 139 men and 214 women aged 70-94 years at the baseline who were independent in both activities of daily living (ADL) and instrumental activities of daily living (IADL) were analyzed in this study. Independent variables, such as cognitive impairment, falls, UI, and other possible factors associated with functional decline were obtained from an interview survey at the baseline. A dependent variable was functional status in ADL and IADL obtained at the time of the 2-year follow-up. During the 2-year follow-up, cognitive function was a significant predictor for both IADL dependence and ADL and/or IADL dependence. Using a group of subjects with Mini Mental State Examination (MMSE) scores of 30-27 points as a reference group, a significant correlation was identified between lower MMSE scores and an increased odds ratio for functional decline. Lower cognitive function was a significant predictor of functional decline, even among those older Japanese whose cognitive function was deemed to be within the normal range.

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PubMed2005

Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan.

BACKGROUND: Cognitive impairment and depressive symptoms impose a heavy burden on the care of the elderly in Japan and Korea, two of the fastest aging nations in Asia. The purpose of this study was to examine and compare factors associated with cognitive impairment and depressive symptoms among older persons in the two countries. METHODS: In 2002, representative samples of community-dwelling people aged 65 and older were selected among residents in Anyang, Korea and Yoita, Japan. Mini-Mental State Examination and Geriatric Depression Scale were used to assess the elderly's mental status. Sociodemographics, physical function, chronic conditions, social support, and health behaviors were examined to identify significant associations. RESULTS: The prevalence of cognitive impairment in older adults was 17.0% in Anyang and 14.6% in Yoita. The rates for depressive symptoms were 15.2% and 19.8%, respectively. Overall, functional capacity was the universal factor significantly associated with mental conditions. Self-rated health and social support were also found to be independently associated with depressive symptoms in the study subjects. Differences in the patterns of association by community, however, were notable for other characteristics. For example, in factors associated with cognitive impairment, sociodemographic factors such as age, gender, and education were significant among Koreans, whereas socio-behavioral factors such as obesity, social support and hospitalization experience were found to be significant for older Japanese residents. CONCLUSIONS: Similarities in the patterns of association indicate the need for joint explorations into the role these factors play in affecting the mental health of older persons. Socioeconomic and regional differentials, however, may account for the disparity in the associations observed, suggesting the importance of developing mental health programs sensitive to the older individual's culture.

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PubMed2005

Arterial pulse wave velocity as a marker of poor cognitive function in an elderly community-dwelling population.

BACKGROUND: Knowledge about potentially modifiable risk factors for cognitive decline is limited at this time. The aim of this study was to determine the cross-sectional relationship between a low level of cognitive function and brachial-ankle pulse wave velocity (baPWV) in a community-dwelling elderly population. METHODS: The study population included 352 community-dwelling Japanese persons ages 70 years and older who participated in a comprehensive health examination in April 2003. None had any history of cardiovascular disease. In addition to conventional medical examinations such as blood pressure and routine blood analyses, cognitive function was tested using the Mini-Mental State Examination (MMSE), and baPWV was determined using a recently developed noninvasive and automatic arterial waveform analyzer (AT-Form). This measure, with well-established validity and reproducibility, reflects both central and peripheral arterial flow. A multivariate logistic regression model tested the possible association between poor cognitive function (an MMSE score < 24) and baPWV. RESULTS: Poor cognitive function was independently associated with the middle tertile of baPWV (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 1.15 to 80.93), age (1-year increment; OR = 1.12, 95% CI = 1.04 to 1.22), and the highest tertile of pulse pressure (OR = 4.70, 95% CI = 1.08 to 20.48) even after multivariate adjustment of data for the effects of age, educational level, and hemodynamic and metabolic antecedents of atherosclerosis. CONCLUSIONS: A high baPWV may be a potent risk factor for poor cognitive function in an elderly community-dwelling population, and this effect is independent of another marker of arterial stiffness: pulse pressure.

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PubMed2005

[Effects of volunteering on the mental and physical health of senior citizens: significance of senior-volunteering from the view point of community health and welfare].

In such an aging society as Japan, with decreasing number of children. Social activity of senior citizens is important for the well-being and the activation of whole societies. Promoting volunteer activities of senior citizens may serve as one useful plan; however, few researchers have examined the impact of volunteer work on the physical and mental health of senior citizens in Japan. In this study, a survey of previous studies that appeared after 1970 in North America, several findings were obtained: (1) Volunteering among senior citizens improves their mental well-being; (2) Few previous studies reported volunteering improves physical health such as protection for mortality and incidence of disability, compared to mental well-being; (3) Effects of volunteering might depend on gender, race, health status, socioeconomic conditions, and social networks of senior citizens--more impact can be expected on physical health of persons of advanced age; (4) Few previous studies focused on interactions of contents of volunteering programs; (5) Although several studies have reported that 40-100 volunteering hours per year were best quantitative level for health, this remains equivocal; (6) The conventional hypothesis that volunteering, through improvement in psychological, physical, and social factors, may improve ones health, needs assessment in terms of actual impact. Moreover, mechanisms of any influence remain to be clarified. From the point of practical use of volunteering as a health promotion program, it is necessary to explore better content and time engaged, as well as the numbers of groups to which senior citizens belong. Long-term longitudinal and intervention studies are desirable in this area in Japan, focusing on older candidates who are still healthy.

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PubMed2005

[Prevalence and characteristics of different types of homeboundness among community-living older adults].

BACKGROUND: Little is known about the epidemiologic features of different types of homeboundness among the elderly. PURPOSE: This cross-sectional study examined prevalence and characteristics of "type 1" and "type 2" homeboundness (see definitions below) among community-living older adults. METHODS: The subjects comprised all residents aged 65 years and over living in Yoita, Niigata Prefecture, and Hatoyama, Saitama Prefecture. Subject data on sociodemographics, and physical, mental and social functioning were collected through in-person interview. Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3, 4, or 5). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e, levels 3, 4, or 5). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We focused on characteristics of "type 1" and "type 2" homeboundness as compared with those of respective controls, ie., non-homebound persons within the same mobility categories. RESULTS: Out of the eligible subjects (1588 in Yoita, and 1135 in Hatoyama), 1544 and 1002 persons participated in the survey (response rates of 97.2% and 88.3%, respectively). Among the participants, "type 1" and "type 2" homeboundness was found for 4.1% and 5.4%, respectively, in Yoita, and 3.3% and 6.8% in Hatoyama. After adjustment for potential confounders such as age, gender and mobility level, we found a significant regional difference in the prevalence of "type 2" but not of "type 1" (OR of "type 2" for Hatoyama/Yoita 1.44; 95% CI 1.02-2.03). Both types of homeboundness increased with advancing age; "type 1" and "type 2" featured in over 10% of persons aged at least 85 years and 80 years, respectively. Even after controlling for potential confounders, "type 2" showed a higher prevalence with walking disability and incontinence, and reported lower self-rated health, more depressed mood, lower functional capacity and lower social functioning. "Type 1" showed a higher prevalence with fear of falls, but a lower prevalence with basic ADL disability and a high score for Intellectual Activity, indicating reduced self-efficacy. CONCLUSIONS: Prevalence of "type 1" and "type 2" homeboundness among community-living older adults differs depending on the residential area and age of the subjects. A substantial proportion of "type 2" homebound persons are at high risk of functional decline, indicating that "type 2" as well as "type 1" homebound persons need care-preventive programs.

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PubMed2005

[Prognosis of different types of homeboundness among community-living older adults: two-year prospective study].

PURPOSE: This 2-year prospective study was conducted to determine prognosis of two different types of homeboundness among community-living older adults and explore whether those types of homeboundness exert independent effects even after controlling for potential confounders. METHODS: Out of all residents aged 65 years and over who lived in Yoita, Niigata, Japan (n = 1,673), 1,544 persons participated in the baseline survey which was conducted in November, 2000 (response rate, 92.2%). They were followed for the subsequent 2 years in terms of mortality, institutionalization and functional status (mobility, IADL, BADL, and cognition). Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into types 1 or 2, based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). Type 1 homebound persons included those who could not get out into the neighborhood without assistance (i.e., levels 3 or over). Type 2 included those who were homebound though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We compared two-year prognosis between the type 2 homebound cases and controls (the non-homebound individuals in levels 1 or 2), or the type 1 homebound and controls (the non-homebound in levels 3 or over). Multiple regression analysis or multiple logistic regression models were used to analyze independent effects of the homebound status on the prognosis, controlling for potential confounders such as age, gender, chronic conditions, functional status, and psychosocial variables at baseline. RESULTS: At baseline there were 1,322 non-homebound in levels 1 or 2 (87.0%), 81 type 2 homebound (5.3%), 39 non-homebound in levels 3 or over (2.6%), and 78 type 1 homebound older persons (5.1%) . As compared to controls, type 2 homebound elderly showed increased risks of functional decline even after controlling for potential confounders. Relative risks of type 2 homeboundness for developing mobility loss, IADL and ADL disability, and cognitive impairment (MMSE < 20) were 3.20(95% CI, 1.60-6.38), 2.85(1.20-6.82), 1.52(0.61-3.75), and 3.05(1.06-8.78) in the partially adjusted model, and 2.49(1.20-5.17), 2.25(0.90-5.63), 1.46(0.54-3.94) and 2.41(0.71-8.17) in the fully adjusted model. Type 1 homebound elderly showed an increased risk for mortality (33.3% vs. 5.1%), but a lower risk for institutionalization (9.0% vs. 25.6%). The independent effect of type 1 was not significant when mortality and institutionalization were combined (relative risk, 2.05[0.54-7.75] in the fully adjusted model). CONCLUSIONS: Type 2 homeboundness is an independent risk factor for functional decline among competent older persons, while the prognosis of older persons with a low functional state is poor, regardless of type 1 homeboundness or not.

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PubMed2005

[Predictors for the onset of different types of homeboundness among community-living older adults: two-year prospective study].

BACKGROUND: Little is known about predictors for the onset of different types of homeboundness among community-living older adults. PURPOSE: This 2-year prospective study examined predictors for the onset of "type 1" and "type2" homeboundness (see definitions below) among community-living older adults. METHODS: Study subjects comprised all residents aged 65 years and over living in Yoita town, Niigata, Japan, who answered the baseline (2000) and follow-up (2002) surveys. Persons were defined as being homebound if he/she went outdoors once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e., level 3 or over). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., level 1 or 2). A stepwise, multiple logistic regression model was used to identify the most parsimonious combination of risk factors for each type of homeboundness. RESULTS: Out of 1,322 persons who were level 1,2 non-homebound at the baseline, 77.6% remained as level 1,2 non-homebound (n = 1,026), but 1.7% were "type 1" homebound (n = 22), and 4.8% were "type 2" homebound (n = 66) at follow-up. The final model for prediction of "type 1" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 2.10; 95%CI: 1.36-3.24), not having a job (OR: 4.42; 95%CI: 1.21-16.2), unable to walk 1 km (OR: 4.24; 95%CI: 1.37-13.1), and a low cognitive function identified as MMSE <24 (OR: 5.22; 95%CI: 1.98-13.8). The final model for prediction of "type 2" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 1.65; 95%CI: 1.32-2.06), a depressive mode indicated by a GDS short version score >5 (OR: 2.18; 95%CI: 1.23-3.88), a low cognitive function (OR: 2.72; 95% CI: 1.47-5.05), not having close friends (OR: 2.30; 95%CI: 1.08-4.87), and not having a walking or calisthetics habit (OR: 2.21; 95%CI: 1.26-3.86). CONCLUSIONS: Reduced physical and mental functioning contribute to the subsequent occurrence of "type 1" homeboundness. Additionally, psychosocial factors are independent predictors of "type 2" homeboundness. These results suggest that different public health strategies might be required for prevention of the different types of homeboundness in Japanese older adults.

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PubMed2004

Relationships between brachial-ankle pulse wave velocity and conventional atherosclerotic risk factors in community-dwelling people.

BACKGROUND: A simple instrument has been developed to measure brachial-ankle pulse wave velocity (baPWV). The aim of the present study was to use this instrument to study the relationship between baPWV and conventional atherosclerotic risk factors. METHODS: Community-dwelling Japanese (632) living in a rural area (234 men and 398 women) participated in a municipal medical health survey that included baPWV measurement and a traditional clinical examination, conducted in June, 2002. RESULTS: Men had a significantly higher baPWV than women. No interaction between gender and age on baPWV was identified. Multiple linear regression analysis indicated that age, hemodynamic factors (diastolic blood pressure, pulse pressure, and heart rate), hemoglobinA1c, current drinking and smoking status, and mild retinal changes had significant independent influences on higher baPWV. CONCLUSIONS: In this rural population, age, gender, and hemodynamic factors were independently associated with baPWV, along with traditional atherosclerotic risk factors, although no significant associations between baPWV and histories of atherosclerotic diseases or subclinical atherosclerosis except for mild retinal changes were demonstrated.

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PubMed2004

[The frequency of going outdoors, and physical, psychological and social functioning among community-dwelling older adults].

PURPOSES: This cross-sectional study examined the relationship between the frequency of going outdoors and physical, psychological, and social functioning among community-dwelling older people. METHODS: Out of all residents aged 65 and over residing in Yoita town, Niigata prefecture (n = 1,673), 1,544 living at home participated in an interview survey held in November 2000. Physical, psychological, and social functioning were compared among four groups defined by the frequency of going outdoors: (1) at least once a day, (2) about once per 2-3 days, (3) about once a week, and (4) seldom. To examine the independent association between the frequency of going outdoors and potential factors, we used multiple logistic regression analysis. RESULTS: Overall distribution of the frequency of going outdoors among the subjects was 76.3% for at least once a day, 13.1% for about once per 2 or 3 days, 3.7% for about once a week, and 6.9% for seldom. The frequency of going outdoors did not differ between genders, but showed significant decrease with advancing age in both sexes. Elderly going outdoors more often were less functionally impaired, scored less for depression and were more socially active than their counterparts going outdoors less often. Multiple logistic regression analysis with the forced entry method identified walking difficulty and fear of falls as the most powerful independent factors associated with going outdoors less than or equal to once a week, while low social activity and a more depressed score were important factors associated with going outdoors about once per 2-3 days. CONCLUSIONS: The frequency of going outdoors may be regarded as a generic health indicator among community-dwelling elderly people.

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PubMed2004

[Present state of social participation and associated factors among middle-aged and older people--a survey in Hatoyama Town, Saitama Prefecture].

BACKGROUND: Many studies have documented that social participation is beneficial for maintaining autonomy and quality of later life. However, little is known about present state of social participation in the Japanese elderly and effective means for its promotion. PURPOSE: To establish what factor might promote social participation in later life, this study was performed to examine the present state of social participation and a number of parameters among middle-aged and older people living in a Japanese community. METHODS: The subjects comprised 1,568 residents aged 55 to 79 years, a 1/3 random sample selected from the total population of this age group in H town, Saitama Prefecture. They were requested to answer the questionnaire delivered by mail. We examined the level of social participation from four aspects: work, social and volunteer activities, individual pursuits and study activities, and analyzed possible associations with demographic, socio-economic, health-, and community-related variables by multiple regression analysis. RESULTS: A total of 964 persons answered the questionnaire (61.5% response rate). Age and gender were associated with each of four social activity domains. Living arrangements (with or without spouse) were independently associated with social and volunteer activity, and study. Educational attainment positively correlated with work and individual pursuits. Residents in a newly constructed town-region were less likely to engage in work, social and volunteer activities, and study than their counterparts living in an older town-region. Those who had a stronger sense of co-living in the community, and who would like to keep their social activity level, were more likely to participate in social and volunteer, as well as study activities and also individual pursuits. People feeling that the municipality should support social activities among residents had a higher level of study activity. CONCLUSIONS: These results show that cultivating a sense of co-living in the community among residents and maintaining their motivation are needed for promoting social participation among older residents. To what extent public support should meet potential needs of social participation remains for further study.

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PubMed2004

[Risk factors associated with onset of urinary incontinence in a community-dwelling elderly population: a 4-year follow-up study].

OBJECTIVE: To estimate the risk factors associated with onset of urinary incontinence in a rural community-dwelling elderly population. METHODS: The study area, village N in Akita Prefecture, is a rural community in which a baseline survey of TMIG-LISA (Tokyo Metropolitan Institute of Gerontology, Longitudinal and Interdisciplinary Study on Aging) was undertaken in 1996. Among the baseline subjects, 760 (314 males and 446 females) community-dwelling elderly people aged over 65, who did not suffer from urinary incontinence at entry of the survey were selected. This cohort has been followed for four years by multi-dimensional medical examination including interviews and physical performance tests, conducted on a yearly basis using similar methods to these for the baseline survey. RESULTS: After the 4-year follow-up, the incidence of urinary incontinence was 7.0% (22/314) in men and 12.3% (55/446) in women. The urinary incontinence group (UIG) had a significantly higher age and lower level of functional fitness at baseline for both sexes. In the UIG, the men but not the women had significantly lower serum levels of albumin and total cholesterol. By the logistic model, age (per 1-year increase: OR = 1.23, 95%CI: 1.11-1.38), and serum albumin (per 0.1 g/dl increase: OR = 0.70, 95%CI: 0.54-0.88) in men; and grip strength (per 1-kg increase: OR = 0.92, 95%CI: 0.86-0.98), social role (per 1-point decrease: OR = 1.81, 95%CI: 1.19-2.73), BMI (per 1-kg/m2 increase: OR = 1.10, 95%CI: 1.01-1.20) and smoking status (never smoker = 1.00, 3 = current smoker: OR = 7.53, 95%CI: 1.36-41.63) in women were independent variables significantly associated with onset of urinary incontinence. CONCLUSIONS: Lifestyle and functional fitness are significantly associated with onset of urinary incontinence in this population. Our findings suggest that intervention programs are needed to improve pelvic floor muscle and to provide social support for the elderly.

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PubMed2003

[Regional differences in ikigai (reason(s) for living) in elderly people--relationship between ikigai and family structure, physiological situation and functional capacity].

The purpose of this paper is a) to make a comparative study of the existence of ikigai (reason(s) for living) in elderly people and its relevance to their family structure, physiological situation and functional capacity in both rural areas and metropolitan suburban areas, and b) position basic research into the structure of ikigai in the near future, by clarifying several related factors, from which the concept of ikigai may be defined. The meaning of the word "ikigai" in Japanese is difficult to express exactly, and specialists in gerontology have varying definitions. If ikigai were translated from Japanese into English, it could be "reason(s) for living", "self-actualization", "meaning of life" and/or "purpose in life". In this paper, ikigai is used to mean "feeling of being alive now and/or individual motivation for living". As of October 2000, we studied 1,544 people aged 65 years and over living in town Y of Niigata Prefecture (rural area), and as of January 2001, we studied 1,002 people in the same age group in town H of Saitama Prefecture (metropolitan suburban area). The above investigations revealed the following characteristics:--(a) Regarding the percentages of persons having or not having ikigai, there were no significant differences between the rural area and the metropolitan suburban area. (b) In both areas, the 3 factors of self-rated level of health, intellectual activeness and social roles, were associated with having ikigai. (c) In the rural area, the family structure was strongly associated with having ikigai, but gender or generation were irrelevant. (d) In the metropolitan suburban area, the hospitalization experience of men was strongly associated with ikigai. Furthermore, there was a strong correlation with generation. In this regard, while the contents of ikigai are seldom examined in detail, clarification of the structure of ikigai should be worked out in the next stage of the study, using covariance structure analysis. In addition the development of concrete plans to promote ikigai by municipal organs could be beneficial.

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PubMed2003

[Factors related to discrepancy in evaluation on functional capacity between reports by community-dwelling older people with cognitive decline and their family members].

Overestimation or underestimation of functional capacity in community-dwelling older people with cognitive impairment was evaluated between the responses of subjects and family members (proxies) by cognitive function level. Out of all the residents aged 65 years and over living in Yoita town, Niigata Prefecture in 2000 (n = 1,673), 1,544 voluntarily participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio-demographic, psychological, physical and medical, and social activity items (2000/11). According to the age of the subject and MMSE score, we defined cognitive decline (MMSE scores < 1 SD below age-specific means, n = 371). 158 pairs among 371 subjects with cognitive decline and their proxies participated in a follow-up survey (2001/11). The subjects themselves underwent MMSE again. 136 subject-proxy pairs reported any complaints of memory-related problem and evaluated higher-level functional capacity (TMIG-IC, Tokyo Metropolitan Institute of Gerontology Index of Competence). We established criteria at follow-up survey as follows: control (n = 29), MMSE scores > 1 SD below age-specific means and CDR (Clinical Dementia Rating) = 0: mild cognitive decline (MCD) (n = 54), 21 < or = MMSE scores < 1 SD below age-specific means or CDR = 0.5); and severe cognitive decline (SCD) (n = 53), MMSE scores 20 < or = CDR > 0.5. SCD subjects significantly overestimated total and Instrumental Self-Maintenance scores in TMIG-IC more than control or SCD subjects. Multiple logistic regression analyses indicated that complaints of memory by the proxy, response by spouse, and higher levels of education were extracted as significantly independent variables affecting overestimation for functional capacity. On the other hand, aging affected underestimation.

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