Suchergebnisse

This book is open access under a CC BY-NC-ND 4.0 license. This open access book is the first compilation that reviews a wide range of social determinants of health (SDHs) for non-communicable diseases (NCDs) and healthy ageing in Japan. With the highest life expectancy and the largest elderly population in the world, Japan has witnessed health inequality by region and social class becoming more prevalent since the 2000s. The first half of this volume describes in detail major NCDs, such as cancers, heart and kidney diseases, diabetes, stroke, and metabolic syndrome. The second half, on the other hand, explores various SDHs relating to healthy ageing. All chapters review and focus on SDHs, particularly health inequality associated with socio-economic status and social capital, which are widely addressed in the field of social epidemiology. The book makes the argument that "Health for All" advocated by the WHO should be implemented based on social justice and benefits for the greater society. Public health researchers and policymakers, both in Japan and other nations, will gain scientific evidence from this book to prepare for the coming era as ageing becomes a global issue.

We aimed to assess the efficacy of a reablement program in improving the independence from long-term care services of older adults with mild disability. This parallel, two-arm, randomized controlled, superiority trial was conducted in Neyagawa, a local government area in Osaka, Japan. Eligible participants were community-dwelling individuals aged ≥65 years certified as support-required level. They were assigned in a 1:1 ratio to receive either a community-based, multicomponent, multidisciplinary, individualized goal-directed, and time-limited intervention (the CoMMIT program) plus standard care or standard care alone. The primary outcome was independence, that is, the nonuse of long-term care services during the three-month follow-up period. The study was terminated early due to slow enrollment. A total of 375 participants were enrolled and randomized to either the intervention (n = 190) or control (n = 185) group. The proportions of independence were 11.1% and 3.8% in the intervention and control groups, respectively (absolute difference: 7.3; 95% confidence interval: 2.0–12.5). There was no difference in the risk of serious adverse events between the groups. The CoMMIT program plus standard care was found superior to standard care alone in enhancing the independence from long-term care services of older adults with mild disability.

BACKGROUND: Farmers may have an increased risk for poor mental health. In connection with this, factors specific to the neighborhood environment such as farm density and the type of agriculture, might be important for mental wellbeing. In this study we aimed to clarify the cross-level interaction on depressive symptoms between farm density at the neighborhood level by type of agriculture and the longest occupation of individuals (farmer or non-farmer). METHODS: Data came from the 2016 wave of the Japan Gerontological Evaluation Study (JAGES) that were linked to governmental agricultural data. Information was analyzed from 147,549 respondents aged 65 years or older, residing in 1024 neighborhoods in 39 municipalities. We calculated farm (crop or animal husbandry) density at the neighborhood level, dividing the number of agricultural management entities by the population. Three-level (individual, neighborhood, and municipality) Poisson regression analysis was used to calculate the prevalence rate ratios of depressive symptoms. RESULTS: The prevalence of depressive symptoms was higher among individuals whose longest occupation was farmer compared to non-farmer. The estimated probability of depressive symptoms by a cross-level interaction analysis showed that among farmers of both genders, those who were residing in neighborhoods where the farm density was low had a higher prevalence of depressive symptoms, regardless of the type of agriculture. The slope of the relationship between depressive symptoms and animal husbandry farm density varied by occupation, with a higher prevalence of depressive symptoms observed in male farmers compared to male non-farmers. CONCLUSIONS: The high prevalence of depressive symptoms among farmers in neighborhoods with a low farm density may reflect a scarcity of formal and informal social support in such communities. The health effects of the neighborhood environment on farmers, such as farm density, which may vary by the type of agriculture, should be further researched.

Abstract Background Social participation is known to predict longevity. However, little is known about the effect of social participation according to an individual's position in civic groups. We evaluated the influence of social position on mortality, using data from a large cohort of Japanese older adults (the AGES cohort). Methods Of 14,804 individuals aged 65 years and older enrolled in the AGES, 14,286 individuals were followed up for approximately 5 years from 2003 to 2008. We performed inverse probability of treatment weighted (IPTW) Cox proportional hazards regression with multiple imputation of missing values to compute hazard ratios (HR) for all-cause mortality according to the individual's position in the community organization(s) to which they belonged. We examined participation in the following civic groups: neighborhood association/senior citizen club/fire-fighting team, religious group, political organization or group, industrial or trade association, volunteer group, citizen or consumer group, hobby group, and sports group or club. The values for IPTW were computed based on demographic variables, socioeconomic status, and self-reported medical condition. Results During 22,718 person-years of follow-up for regular members of community groups and 14,014 person-years of follow-up for participants in leadership positions, 479 deaths and 214 deaths were observed, respectively. Relative to regular members, crude HR for all-cause mortality for occupying leadership positions (e.g. president, manager, or having administrative roles) was 0.72 (95 % CI:0.62–0.85). The IPTW-HR was 0.88 (95 % CI: 0.79–0.99) for participants occupying leadership positions. Conclusions Holding leadership positions in community organization(s) may be more beneficial to health than being regular members.

Abstract

Background
This study aims to investigate the association and dose-response relationship between depression, dementia, and all-cause mortality based on a national cohort study of elderly people in Japan.


Methods
We conducted a longitudinal study of 44,546 participants aged ≥65 from 2010-2019 Japanese Gerontological Evaluation Study (JAGES). The Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms and the long-term care insurance (LTCI) was used to assess dementia. Fine-gray models and Cox proportional hazard models were used to explore the effect of depression severity on the incidence of dementia and all-cause mortality, respectively. Causal mediation analysis (CMA) to explore the extent of association between dementia-mediated depression and all-cause mortality.


Results
We found that both minor and major depressive symptoms were associated with the increased cumulative incidence of dementia and all-cause mortality, especially major depressive symptoms (P < 0.001). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia were 1.25 (1.19-1.32) for minor depressive symptoms and 1.42 (1.30-1.54) for major depressive symptoms in comparison to non-depression; P for trend < 0.001. The multivariable-adjusted HRs and 95% CIs for all-cause mortality were 1.27 (1.21-1.33) for minor depressive symptoms and 1.51 (1.41-1.62) for major depressive symptoms in comparison to non-depression; P for trend < 0.001. Depression has a stronger impact on dementia and all-cause mortality among the younger group. In addition, dementia significantly mediated the association between depression and all-cause mortality.


Discussion
Interventions targeting major depression may be an effective strategy for preventing dementia and premature death.