Social isolation, loneliness, and their correlates in older Japanese adults

BACKGROUND: Loneliness and social isolation are elevated in older adults and associated with a range of detrimental outcomes. Despite this, there has been little research on these phenomena or on similarities and differences in their occurrence or combination in older Japanese adults. The current study aims to (i) determine what factors are associated with social isolation and loneliness among older adults in Japan; and (ii) describe the characteristics of individuals who are socially isolated but not lonely, as well as those who feel lonely but are not socially isolated. METHODS: Data were analysed from 13 766 adults aged ≥65 years who participated in the 2019 wave of the Japan Gerontological Evaluation Study. Poisson regression analysis was used to examine associations. RESULTS: Among older Japanese adults, the attributes of higher age, male gender, lower socioeconomic status, being a welfare recipient, and having depressive symptoms were associated with social isolation, while lower socioeconomic status, unemployment, welfare receipt, and poor physical and mental health were associated with loneliness. In addition, better educated, and mentally and physically healthy people were less likely to feel lonely even when socially isolated, while people who were not working and who had mental or physical health problems were more likely to feel lonely even if they were not socially isolated. DISCUSSION: Our results indicate that in order to reduce unwanted social isolation and loneliness among older Japanese adults, in the first instance the focus should be on those individuals who are socioeconomically disadvantaged and unhealthy

Changes in social relationships by the initiation and termination of public assistance in the older Japanese population: A JAGES panel study

Public assistance recipients in Japan are financially empowered by social welfare but are also exposed to social stigma. Therefore, when their status of receiving public assistance changes, the conditions of their social life likely change. We examined whether the social relationships of older adults receiving public welfare are influenced by either starting or terminating their use of public assistance. This study used the Japan Gerontological Evaluation Study panel data from 2013 to 2016. To measure social relationships, we used four indicators: the frequency of meeting with friends, the number of friends whom the participants had met with in the past month, their frequency of participating in sports clubs, and their frequency of participating in hobby clubs. In the analyses, changes in social relationships between 2013 and 2016 were used as the study outcomes. Linear regression analyses were conducted to examine if their social relationships changed before and after starting or terminating public assistance while adjusting for confounders. We found that people who stopped receiving public assistance experienced an increase in their frequency of meeting with friends (coefficient: 0.56; 95% CI: 0.06, 1.07), the number of friends (coefficient: 0.60; 95% CI: 0.20, 0.99), participation in sports clubs (coefficient: 0.91; 95% CI: 0.46, 1.39), and participation in hobby clubs (coefficient: 0.70; 95% CI: 0.26, 1.13) compared to those who continued to receive public assistance. Contrarily, the measured social relationships did not change after the participants started receiving public assistance. Our main findings were that terminating one's reception of public assistance increases informal socializing and social participation while starting public assistance does not interrupt pre-existing relationships. These findings contribute to the literature by adding that social relationships are not negatively influenced by either terminating or starting public assistance. Targeted promotions of social connections would effectively maintain the health statuses of low-income older adults

Functional disability trajectories at the end of life among Japanese older adults: findings from the Japan Gerontological Evaluation Study (JAGES)

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

Suicidal ideation and suicide attempts among older recipients of public welfare assistance in Japan

[Background] The high suicide rate among older adults is an important public health issue. Financial insecurity has been linked to suicidal behaviour. Despite this, as yet, there has been little research on suicide-related behaviours among older recipients of public welfare. This study will examine if suicidal ideation and suicide attempts are more prevalent in older recipients of public welfare assistance in Japan. [Methods] This cross-sectional study analysed data from 16 135 adults aged ≥65 years who participated in the 2019 wave of the Japan Gerontological Evaluation Study. Information was obtained on receiving public welfare assistance, lifetime suicidal ideation and attempts, and a variety of covariates. Poisson regression analysis with robust variance estimates was used to examine associations. [Results] Suicidal ideation was reported by 4.8% of the participants, while the corresponding figure for attempted suicide was 2.2%. In fully adjusted analyses public welfare recipients had an almost 1.5 times higher prevalence of lifetime suicidal ideation (prevalence ratio, PR 1.47, 95% CI 1.02 to 2.13), and an almost two times higher prevalence of attempted suicide (PR 1.91, 95% CI 1.20 to 3.04) when compared with their counterparts not receiving public welfare assistance. [Conclusion] Older recipients of public welfare have a higher prevalence of suicidal behaviour in Japan. An urgent focus is now warranted on this vulnerable population to determine the specific factors underlying this association

Combined effects of eating alone and living alone on unhealthy dietary behaviors, obesity and underweight in older Japanese adults: Results of the JAGES

AbstractWe examined whether eating alone is associated with dietary behaviors and body weight status, and assessed the modifying effects of cohabitation status in older Japanese people. Data from the 2010 Japan Gerontological Evaluation Study, with a self-reported questionnaire for 38,690 men and 43,674 women aged ≥65 years, were used. Eating status was classified as eating with others, sometimes eating alone, or exclusively eating alone. We calculated adjusted prevalence ratios (APRs) of unhealthy dietary behaviors, obesity, and underweight, adjusting for age, education, income, disease, and dental status using Poisson regression. Overall, 16% of men and 28% of women sometimes or exclusively ate alone. Among those who exclusively ate alone, 56% of men and 68% of women lived alone. Men who exclusively ate alone were 3.74 times more likely to skip meals than men who ate with others. Among men who exclusively ate alone, those who lived alone had a higher APR than men who lived with others. Compared with subjects who ate and lived with others, the APRs of being obese (BMI ≥ 30.0 kg/m2) among men who exclusively ate alone were 1.34 (1.01–1.78) in those who lived alone and 1.17 (0.84–1.64) in those who lived with others. These combined effects of eating and living alone were weaker in women, with a potential increase in the APRs among those who ate alone despite living with others. Men who exclusively ate alone were more likely to be underweight (BMI < 18.5 kg/m2) than men who ate with others in both cohabitation statuses. Eating alone and living alone may be jointly associated with higher prevalence of obesity, underweight and unhealthy eating behaviors in men

Relative deprivation in income and mortality by leading causes among older Japanese men and women: AGES cohort study

Background: Relative deprivation of income is hypothesised to generate frustration and stress through upward social comparison with one's peers. If psychosocial stress is the mechanism, relative deprivation should be more strongly associated with specific health outcomes, such as cardiovascular disease (compared with other health outcomes, eg, non-tobacco-related cancer). Methods: We evaluated the association between relative income deprivation and mortality by leading causes, using a cohort of 21 031 community-dwelling adults aged 65 years or older. A baseline mail-in survey was conducted in 2003. Information on cause-specific mortality was obtained from death certificates. Our relative deprivation measure was the Yitzhaki Index, derived from the aggregate income shortfall for each person, relative to individuals with higher incomes in that person's reference group. Reference groups were defined according to gender, age group and same municipality of residence. Results: We identified 1682 deaths during the 4.5 years of follow-up. A Cox regression demonstrated that, after controlling for demographic, health and socioeconomic factors including income, the HR for death from cardiovascular diseases per SD increase in relative deprivation was 1.50 (95% CI 1.09 to 2.08) in men, whereas HRs for mortality by cancer and other diseases were close to the null value. Additional adjustment for depressive symptoms and health behaviours (eg, smoking and preventive care utilisation) attenuated the excess risks for mortality from cardiovascular disease by 9%. Relative deprivation was not associated with mortality for women. Conclusions: The results partially support our hypothesised mechanism: relative deprivation increases health risks via psychosocial stress among men

ショウチイキ ネットワーク カツドウ シエン データ カンリ ソフト ノ カイハツ ト セッケイ シソウ ヨウエンゴ コウレイシャ エノ ミマモリ カツドウ ノ ヒョウカ ツール

本研究では， 住民同士による地域の要援護高齢者への見守り活動 （小地域ネットワーク活動） の重要性と課題を踏まえて， 「小地域ネットワーク活動支援データ管理ソフト」 の試行版を開発した． 本ソフトでは， 要援護高齢者と間接的な支援者を含めた協力員の基本情報をデータベース化することによって， 小地域ネットワーク活動事業の明確化と達成度の向上， および， 当活動にかかる管理業務の負担軽減を図った． それと同時に， 本ソフトは， ①要援護高齢者にとって必ずしも親しい人に含まれない程度の近隣関係の様態をダイアド単位で正確に把握できる点， ②要援護高齢者の社会的ネットワークの経時的な変化を把握できる点， ③通常の社会調査を拒否しがちな人を含めて要援護高齢者の基本情報を広範に収集できる点， ④地域福祉実践の効果評価に必要なデータを提供する点において， 関連する実証研究にとって意義のあるツールになると考えられる． 今後の課題としては， 本ソフト導入による職員の業務負担軽減に関する検証作業のほか， 要援護高齢者に関する付加情報の選定や現場での個人情報の取り扱いに関する方針の整理， 他地域における同種の活動への汎用性の検討などが残されている

チイキ トクセイ ニ ソクシタ インフォーマルケア ノ ジッセン カダイ チュウシュツ ノ ココロミ 2 フクシ デ マチヅクリ オ メザス タカハマシ デノ チョウサ カラ

本論文では， 愛知県高浜市を研究対象地域とし， フォーマルケアだけでは対応できないニーズや把握しきれない高齢者等に対して， 住民によるまちづくりと連携して取り組んでいる地域ケアの現状と課題を明らかにすることを目的とした． そのため， 同市のフォーマルケア関係者と， 同市における 「福祉でまちづくり」 の中心的な担い手である 「まちづくり協議会」 を含むインフォーマルケア関係者へのヒアリング調査を踏まえ， その中心的な関係者 10 名を参加者として， 2 回にわたりフォーカスグループ面接を行った．その結果， フォーマルケアの側で取り組むべき課題としては， 制度の枠に縛られずに行える共生ケアの仕組みづくりなどが， またインフォーマルケアの側で取り組むべき課題としては， サービスや支援から取り残されている人を日々の訪問活動等を通じて継続的に把握し， 必要な支援へつなぐ仕組みづくりなどが指摘された．なお， フォーカスグループ面接の場では， インフォーマルケアが把握したニーズをフォーマルケアにつなげていくという， 一部のまちづくり協議会の取り組みが参加者間で共有された． このようにインフォーマルケアからフォーマルケアへ向けた協働のあり方が例示されたことによって， 同市における 「福祉でまちづくり」 が今後新たな展開を見せることが期待される