Impact of Pain on Incident Risk of Disability in Elderly Japanese

2017 ◽  
Vol 126 (4) ◽  
pp. 688-696 ◽  
Author(s):  
Yu Kaiho ◽  
Yumi Sugawara ◽  
Kemmyo Sugiyama ◽  
Yasutake Tomata ◽  
Yasuhiro Endo ◽  
...  
Keyword(s):  
Severe Pain ◽  
Functional Disability ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Pain Severity ◽  
Joint Disease ◽  
Moderate Pain ◽  
Term Care ◽  
Elderly Japanese ◽  
Multivariate Hazard Ratio

Abstract Background Although several cross-sectional studies have reported that pain is associated with functional disability in the elderly, data regarding a longitudinal association between pain and disability are inconsistent. This study aimed to investigate the association of pain severity with subsequent functional disability due to all causes as well as stroke, dementia, and joint disease/fracture. Methods The authors conducted a prospective cohort study of 13,702 Japanese individuals aged 65 yr or older. Information regarding pain severity during the previous 4 weeks and other lifestyle factors was collected via questionnaire in 2006. Data on the incidence of functional disability were retrieved from the Long-term Care Insurance database. Cox proportional hazards regression analysis was used to estimate the multivariate-adjusted hazard ratios for incident functional disability. Results The authors documented 2,686 (19.6%) cases of incident functional disability. The multivariate hazard ratio of functional disability was 1.15 (95% CI, 1.02 to 1.31) among respondents with moderate pain and 1.31 (95% CI, 1.12 to 1.54) among respondents with severe pain in comparison with those without pain (P trend < 0.001). These positive associations were particularly remarkable for disability due to joint disease/fracture: the multivariate hazard ratio was 1.88 (95% CI, 1.37 to 2.58) for moderate pain and 2.76 (95% CI, 1.93 to 3.95) for severe pain (P trend < 0.001). There was a negative association between pain severity and disability due to dementia (P trend = 0.041) and no significant association between pain severity and disability due to stroke. Conclusions Among elderly Japanese individuals, the authors found a significant positive association between pain severity and future incident functional disability.

scholarly journals Impact of oral self-care on incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 study

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017946 ◽  
Author(s):  
Shino Bando ◽  
Yasutake Tomata ◽  
Jun Aida ◽  
Kemmyo Sugiyama ◽  
Yumi Sugawara ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Functional Disability ◽  
Self Care ◽  
Community Dwelling ◽  
Tooth Brushing ◽  
Term Care ◽  
Increased Risk ◽  
Long Term Care Insurance ◽  
Elderly Japanese

ObjectivesTo assess whether oral self-care (tooth brushing, regular dental visits and use of dentures) affects incident functional disability in elderly individuals with tooth loss.DesignA 5.7-year prospective cohort study.SettingOhsaki City, Japan.Participants12 370 community-dwelling individuals aged 65 years and older.Primary outcome measuresIncident functional disability (new long-term care insurance certification).ResultsThe 5.7-year incidence rate of disability was 18.8%. In comparison with participants who had ≥20 teeth, the HRs (95% CIs) for incident functional disability among participants who had 10–19 and 0–9 teeth were 1.15 (1.01–1.30) and 1.20 (1.07–1.34), respectively (p trend<0.05). However, the corresponding values for those who brushed their teeth ≥2 times per day were not significantly higher in the ‘10–19 teeth’ and ‘0–9 teeth’ groups (HRs (95% CI) 1.05 (0.91–1.21) for participants with 10–19 teeth, and 1.09 (0.96–1.23) for participants with 0–9 teeth), although HRs for those who brushed their teeth <2 times per day were significantly higher (HRs (95% CI) 1.32 (1.12–1.55) for participants with 10–19 teeth, and 1.33 (1.17–1.51) for participants with 0–9 teeth). Such a negating association was not observed for other forms of oral self-care.ConclusionsTooth brushing may partially negate the increased risk of incident functional disability associated with having fewer remaining teeth.

scholarly journals Pre-Existing Disability and Its Risk of Fragility Hip Fracture in Older Adults

2019 ◽  
Vol 16 (7) ◽  
pp. 1237
Author(s):  
Jayeun Kim ◽  
Soong-Nang Jang ◽  
Jae-Young Lim
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Mental Disabilities ◽  
Term Care ◽  
Fragility Hip Fracture

Background: Hip fracture is one of the significant public concerns in terms of long-term care in aging society. We aimed to investigate the risk for the incidence of hip fracture focusing on disability among older adults. Methods: This was a population-based retrospective cohort study, focusing on adults aged 65 years or over who were included in the Korean National Health Insurance Service–National Sample from 2004 to 2013 (N = 90,802). Hazard ratios with 95% confidence interval (CIs) were calculated using the Cox proportional hazards model according to disability adjusted for age, household income, underlying chronic diseases, and comorbidity index. Results: The incidence of hip fracture was higher among older adults with brain disability (6.3%) and mental disability (7.5%) than among those with other types of disability, as observed during the follow-up period. Risk of hip fracture was higher among those who were mildly to severely disabled (hazard ratio for severe disability = 1.59; 95% CI, 1.33–1.89; mild = 1.68; 95% CI, 1.49–1.88) compared to those who were not disabled. Older men with mental disabilities experienced an incidence of hip fracture that was almost five times higher (hazard ratio, 4.98; 95% CI, 1.86–13.31) versus those that were not disabled. Conclusions: Older adults with mental disabilities and brain disability should be closely monitored and assessed for risk of hip fracture.

scholarly journals Combination of diabetes mellitus and lack of habitual physical activity is a risk factor for functional disability in Japanese

2020 ◽  
Vol 8 (1) ◽  
pp. e000901
Author(s):  
Kazuya Fujihara ◽  
Yasuhiro Matsubayashi ◽  
Mayuko Harada Yamada ◽  
Masaru Kitazawa ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Physical Activity ◽  
Functional Disability ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Habitual Physical Activity ◽  
Term Care ◽  
Patients With Diabetes ◽  
The Impact

ObjectiveDeclining healthy life expectancy due to functional disability is relevant and urgent because of its association with decreased quality of life and also for its enormous socioeconomic impact. The aim of this study is to examine the impact of diabetes, hypertension, dyslipidemia and physical activity habits on functional disability among community-dwelling Japanese adults.Research design and methodsThis is a population-based retrospective cohort study including 9673 people aged 39–98 years in Japan (4420, men). Functional disability was defined as a condition meeting Japan’s new long-term care insurance certification requirements for the need of assistance in the activities of daily living whether by caregivers or assistive devices. Cox proportional-hazards regression model identified variables related to functional disability.ResultsMedian follow-up was 3.7 years. During the study period, 165 disabilities occurred in the overall study population. Multivariate analysis showed that diabetes (HR 1.74 (95% CI 1.12 to 2.68)) and no physical activity habit (HR 1.83 (1.27 to 2.65)) presented increased risks for disability. HR for disability increased with the number of risk factors (HR of individuals with four conditions, 3.96 (1.59 to 9.99) vs individuals with none of those conditions as a reference). HR for disability among patients with diabetes with and without a physical activity habit was 1.68 (0.70 to 4.04) and 3.19 (1.79 to 5.70), respectively, compared with individuals without diabetes with a physical activity habit.ConclusionsThe combination of diabetes and lack of habitual physical activity is predictive of functional disability in Japanese. Habitual physical activity attenuates the risk of functional disability in patients with diabetes.

scholarly journals FRI0396 HOW DOES OSTEOARTHRITIS PAIN IMPACT FUNCTION, MOBILITY AND REQUIREMENT FOR HELP IN DAILY ACTIVITIES IN EUROPEAN PATIENTS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 796.2-796
Author(s):  
P. G. Conaghan ◽  
L. Abraham ◽  
P. Graham-Clarke ◽  
L. Viktrup ◽  
J. C. Cappelleri ◽  
...  
Keyword(s):  
Physical Function ◽  
Functional Impairment ◽  
Severe Pain ◽  
Functional Limitations ◽  
Pain Severity ◽  
Daily Activities ◽  
Pharmacologic Therapy ◽  
Moderate Pain ◽  
Mild Pain ◽  
Impact Function

Background:Symptomatic osteoarthritis (OA) leads to functional limitations and loss of independence. OA management focuses on pain relief and preserving physical function using non-pharmacologic and pharmacologic therapy. Additionally, patients commonly manage OA pain by avoiding activities that exacerbate their pain. Informal care, i.e. assistance from an unpaid caregiver, plays a major role in the total care provided to patients with chronic diseases like OA.Objectives:To evaluate how OA pain severity affects physical functioning and the subsequent need for assistance with mobility and daily activities in 5 EU countries: France, Germany, Italy, Spain and UK.Methods:Data were drawn from the Adelphi OA Disease Specific Programme (2017-18), a point-in-time study of physicians and their OA patients. Patients rated their average pain intensity over the last week on a 0-10 scale (0 = no pain; 10 = worst possible pain) and were then categorised into mild (0-3), moderate (4-6) and severe (7-10) pain groups. Patients also provided an assessment of their physical function (0-10 WOMAC scale where higher scores indicated greater functional impairment), impact on mobility, whether caregiver assistance was required, daily activities requiring caregiver assistance and home modifications made due to their OA. Physicians also rated patients’ functioning on a 0 to 10 scale (0 = fully functional; 10 = completely impaired). Comparisons among pain severity groups were made using chi-squared tests and analysis of variance.Results:The analysis included 1750 OA patients: 24% mild pain (n=413); 47% moderate pain (n=822); 29% severe pain (n=515). The patients were predominantly women (58%) and had a mean (SD) age of 65.6 (11.5).Increased pain severity was associated with greater functional impairment scores as reported by patients (WOMAC scores: mild pain=2.1; moderate pain=4.1; severe pain=5.9) and physician-rated functional impairment (mild pain=3.5; moderate pain=4.3; severe pain=5.6). Mobility was impacted for 78% of patients with severe pain (vs. 41% mild; 63% moderate) and the need for a walking aid such as a walking stick or walking frame increased with worsening severity; wheelchair assistance was needed for 7% of severe patients (compared with <1% of mild or moderate patients). Furthermore, 31% of patients with severe pain reported having to modify their home due to their OA (vs. 11% mild; 18% moderate [p<0.001]), typically adapting their bathroom (23%) or fitting a stairlift (6%).The need for assistance from a caregiver to help with daily activities was associated with an increase in patients’ pain (9% mild; 20% moderate; 42% severe [p<0.001]). For most patients this was an immediate family member, however, the proportion of patients paying for professional care also increased with severity (1% mild; 2% moderate; 7% severe). Taking the patient to work or doctor’s appointments; help with shopping; preparing/cooking meals and help with travelling out of the home were most frequently reported activities needing caregiver assistance.Conclusion:In this study of European patients, increased pain severity was associated with greater functional impairment and impact on mobility as expected; however, this study highlights the substantial need for assistance with daily activities as well as modifications to the home. The unseen costs to the patient with moderate to severe OA pain are significant.Disclosure of Interests:Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer, Lucy Abraham Shareholder of: Pfizer, Employee of: Pfizer, Peita Graham-Clarke Shareholder of: Eli Lilly and Co, Employee of: Eli Lilly and Co, Lars Viktrup Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Joseph C Cappelleri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Craig Beck Shareholder of: Pfizer, Employee of: Pfizer, Andrew G Bushmakin Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Niall Hatchell: None declared, Emily Clayton: None declared, James Jackson: None declared

scholarly journals The Relationship Between Pain and Psychological Distress During the COVID-19 Pandemic: Is Social Technology Use Protective?

Pain Medicine ◽  
2021 ◽  
Author(s):  
Yulin Yang ◽  
Hanna Grol-Prokopczyk ◽  
M Carrington Reid ◽  
Karl Pillemer
Keyword(s):  
Older Adults ◽  
Psychological Distress ◽  
Technology Use ◽  
Severe Pain ◽  
Well Being ◽  
Pain Severity ◽  
Social Technology ◽  
Moderate Pain ◽  
Social Technologies ◽  
The Relationship

Abstract Objectives The COVID-19 pandemic and resulting shelter-in-place orders have profoundly changed the everyday social environment. This study examines the relationship between pain and psychological distress (depression, anxiety, and loneliness) among U.S. adults ages 54 and older during the pandemic. We also test whether use of technology for social purposes moderates the association between pain severity and psychological distress. Methods Using cross-sectional data on 1,014 adults ages 54 and older (pain free, n = 637; mild pain, n = 106; moderate pain, n = 227; and severe pain, n = 64) from the 2020 Health and Retirement Study COVID-19 Project (Early, Version 1.0), we conducted regression analyses to test the association between pain severity and psychological outcomes and to assess social technology use frequency as a moderator. Results Compared with their pain-free peers, participants with mild-to-moderate pain reported more depressive symptoms and greater loneliness; those with severe pain reported higher levels of depression, anxiety, and loneliness. Social technology use was associated with lower levels of depression and loneliness. However, interaction analyses show that social technology use predicted an increase in depression for individuals with pain but a decrease in depression among pain-free individuals. For anxiety and loneliness, no significant effects of social technology use were observed. Conclusion Older adults with pain are at high risk of depression, anxiety, and loneliness during the pandemic. Although social technologies have become a common alternative to face-to-face interactions during the COVID-19 crisis, and overall they can provide mental health benefits, our results suggest that social technologies can be detrimental to psychological well-being among people with pain. These findings can inform technology-based interventions aiming to promote well-being among older adults with pain.

scholarly journals Dietary Patterns and Self-reported Incident Disability in Older Adults

2018 ◽  
Vol 74 (8) ◽  
pp. 1331-1337 ◽  
Author(s):  
Puja Agarwal ◽  
Yamin Wang ◽  
Aron S Buchman ◽  
David A Bennett ◽  
Martha C Morris
Keyword(s):  
Older Adults ◽  
Sex Education ◽  
Functional Disability ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Mobility Disability ◽  
The Mediterranean ◽  
Adl Disability ◽  
The Mind ◽  
Mind Diet

Abstract Background or Objectives Disability in older adults is associated with low quality of life and higher mortality. Diet may be a potentially important public health strategy for disability prevention in aging. We examined the relations of the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) diets to functional disability in the Rush Memory and Aging Project. Methods A total of 809 participants (mean age = 80.7 ± 7.2 years, 74% female) without functional disability at baseline were followed for an average of 5.3 years. Standardized measures for self-reported disability including, activities of daily living ADL), instrumental ADL, and mobility disability were assessed annually. The diet scores were computed based on a validated food frequency questionnaire administered at baseline. Results In Cox proportional hazards models adjusted for age, sex, education, smoking, physical activity, and total calories, the second (hazard ratio = 0.75, 95% CI: 0.60–0.95) and third tertiles (hazard ratio = 0.67, 95% CI: 0.53–0.86) of MIND diet scores had lower rates of ADL disability compared to the lowest tertile (p for trend = .001), whereas only the third tertiles of the Mediterranean (hazard ratio = 0.73, 95% CI: 0.57–0.94) and DASH (hazard ratio = 0.75, 95% CI: 0.59–0.95) diets were significantly associated with ADL disability. Instrumental ADL disability was inversely and linearly associated with the MIND diet score only (p for trend = .04). Mobility disability was associated with the MIND (p for trend = .02), Mediterranean (p for trend = .05) and DASH (p for trend = .02) diet scores. Conclusion These findings are encouraging that diet may be an effective strategy for the prevention of functional disability in older adults.

scholarly journals Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuko Takahashi ◽  
◽  
Kozo Tanno ◽  
Yuki Yonekura ◽  
Masaki Ohsawa ◽  
...  
Keyword(s):  
Functional Disability ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Large Population ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Self Rated Health ◽  
Japanese Elderly ◽  
Community Dwellers

Abstract Background Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study. Methods A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex. Results The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes). Conclusion Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.

scholarly journals 828Dietary Variety and Incident Disabling Dementia in Elderly Japanese Adults

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Yuri Yokoyama ◽  
Akihiko Kitamura ◽  
Yu Nofuji ◽  
Satoshi Seino ◽  
Hidenori Amano ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Dietary Variety ◽  
Japanese Adults ◽  
Elderly Japanese ◽  
A Prospective Study

Abstract Background Although consuming a variety of foods is an internationally accepted recommendation for a healthy diet, little is known about the association between dietary variety and incident dementia. This study aimed to examine the association between dietary variety and incident disabling dementia in community-dwelling elderly Japanese adults. Methods We conducted a prospective study of 721 participants (age range: 65–97 years) of the 2012–2013 Kusatsu Longitudinal Study. Dietary variety was assessed based on a food frequency questionnaire that encompassed the 10 main food components of Japanese meals: meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruit, seaweed, and fats/oils). Participants were then categorized into low (0–2 points), middle (3–5 points), and high (6–10 points) groups based on the scores. Data regarding incident disabling dementia were retrieved from the public Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs). Results During the median follow-up of 6.5 years, the incidence of disabling dementia was 9.3%. After adjusting for confounders, the multivariate HR for incident disabling dementia was 0.52 (95% CI, 0.27–1.00) for participants in the highest category of the dietary variety score compared to that for those in the lowest category. Conclusions Greater dietary variety is associated with a reduced risk of incident disabling dementia in elderly Japanese adults. Key messages Consuming a variety of foods may be necessary for dementia prevention.

scholarly journals The effect of the 2018 Japan Floods on cognitive decline among long-term care insurance users in Japan: a retrospective cohort study

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Shuhei Yoshida ◽  
Saori Kashima ◽  
Masatoshi Matsumoto
Keyword(s):  
Cognitive Decline ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Residential Environment ◽  
Cox Proportional Hazards Model ◽  
Term Care ◽  
Hazards Model

Abstract Background The July 2018 Japan Floods caused enormous damage to western Japan. Such disasters can especially impact elderly persons. Research has shown that natural disasters exacerbated a decline in cognitive function, but to date, there have been no studies examining the effects of this disaster on the elderly. The object of this study was to reveal the effect of this disaster in terms of cognitive decline among the elderly. Methods Study participants were certified users of the long-term care insurance (LTCI) system in Hiroshima, Okayama, and Ehime prefectures from May 2018 to June 2018. The observation period was from July 2018 to December 2018. Our primary outcome was cognitive decline after the disaster using a dementia symptomatology assessment. In addition to a crude model, a multivariate Cox proportional hazards model was used to assess the cognitive decline of victims, adjusting for age classification, gender, the level of dementia scale before the disaster occurred, residential environment, whether a participant used facilities shut down after the disaster, and population density. After we confirmed that the interaction term between victims and residential environment was statistically significant, we stratified them for the analysis. Results The total number of participants was 264,614. Victims accounted for 1.10% of the total participants (n = 2,908). For the Cox proportional hazards model, the hazard ratio of the victims was 1.18 (95% confidential interval (CI): 1.05–1.32) in the crude model and 1.12 (95% CI: 1.00–1.26) in the adjusted model. After being stratified by residential environment, the hazard ratio of home victims was 1.20 (95% CI: 1.06–1.36) and the hazard ratio of facility victims was 0.89 (95% CI: 0.67–1.17). Conclusions This study showed that elderly living at home during the 2018 Japan Floods were at risk for cognitive decline. Medical providers, care providers, and local governments should establish a system to check on the cognitive function of elderly victims and provide necessary care support.

scholarly journals Community social capital and the onset of functional disability among older adults in Japan: a multilevel longitudinal study using Japan Gerontological Evaluation Study (JAGES) data

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029279 ◽  
Author(s):  
Taiji Noguchi ◽  
Katsunori Kondo ◽  
Masashige Saito ◽  
Hiroko Nakagawa-Senda ◽  
Sadao Suzuki
Keyword(s):  
Social Capital ◽  
Social Cohesion ◽  
Primary Outcome ◽  
Functional Disability ◽  
Outcome Measure ◽  
Evaluation Study ◽  
Primary Outcome Measure ◽  
Cox Proportional Hazards ◽  
Care Needs ◽  
Term Care

ObjectiveThe present study examined the association between community social capital and the onset of functional disability among older Japanese people by using validated indicators of social capital and a prospective multilevel design.DesignProspective cohort studySettingWe used data from the Japan Gerontological Evaluation Study, established from August 2010 to January 2012 in 323 districts.ParticipantsThe target population was restricted to non-institutionalised people aged 65 years or older who were independent in activities of daily living. Participants included 73 021 people (34 051 men and 38 970 women) who were followed up over a 3-year period.Primary outcome measureThe primary outcome measure was the onset of functional disability, defined as a new registration in public long-term care insurance system records with a care-needs level of two or above, analysed with multilevel Cox proportional hazards regression models by community social capital (civic participation, social cohesion and reciprocity).ResultsThe mean age of participants was 73.3 years (SD=6.0) for men and 73.8 years (SD=6.2) for women. During the study period, the onset of functional disability occurred in 1465 (4.3%) men and 1519 (3.9%) women. Of three community social capital variables, social cohesion significantly reduced the risk of onset of functional disability (HR 0.910; 95% CI 0.830 to 0.998) among men, after adjusting for individual social and behavioural variables. There was no significant effect among women.ConclusionsLiving in a community with rich social cohesion is associated with a lower incidence of onset of functional disability among older Japanese men.

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