scholarly journals Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomo Takasugi ◽  
Taishi Tsuji ◽  
Masamichi Hanazato ◽  
Yasuhiro Miyaguni ◽  
Toshiyuki Ojima ◽  
...  
Keyword(s):  
Older People ◽  
Educational Attainment ◽  
Urban Areas ◽  
Evaluation Study ◽  
Community Level ◽  
Variable Model ◽  
Term Care ◽  
Individual Level ◽  
Dementia Incidence ◽  
Individual Survival

Abstract Background As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. Methods We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1–87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01–1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02–1.13), there was no association in urban areas (HR: 1.03; 0.99–1.06). Conclusions Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.

scholarly journals Community-level Educational Attainment and Dementia: A 6-year Longitudinal Multilevel Study in Japan

2021 ◽  
Author(s):  
Tomo Takasugi ◽  
Taishi Tsuji ◽  
Masamichi Hanazato ◽  
Yasuhiro Miyaguni ◽  
Toshiyuki Ojima ◽  
...  
Keyword(s):  
Older People ◽  
Educational Attainment ◽  
Urban Areas ◽  
Community Level ◽  
Contextual Effect ◽  
The European Union ◽  
Term Care ◽  
Individual Level ◽  
Dementia Incidence ◽  
Lower Educational Attainment

Abstract Background:Understanding of the association between community-level socioeconomic status and dementia is insufficient. We examined the contextual effect of community-level prevalence of lower educational attainment on the risk of dementia incidence. This work further explored the potential differences in associations for urban and non-urban areas. Methods:We analyzed a six-year prospective cohort data from the Japan Gerontological Evaluation Study, a nationwide survey between 2010 and 2012 of 49,888 (23,339 men and 26,549 women) physically and cognitively independent individuals aged ≥65 years from 346 communities at 16 municipalities in seven prefectures. Dementia incidence was assessed through the public long-term care insurance system by the Ministry of Health, Labor, and Welfare in Japan. Educational years were dichotomized as ≤9 years and ≥10 years. We classified urban and non-urban areas using a Functional Urban Area defined by the European Union (EU) and Organisation for Economic Co-operation and Development (OECD). We performed a two-level (community- and individual-level) multilevel survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results:The cumulative incidence of dementia during the follow-up period was 10.3%. The mean proportion of educational attainment with ≤9 years was 41.1% (range, 4.7%–88.4%). Higher prevalence of community-level lower educational attainment had a significant association with a higher risk of dementia incidence (HR, 1.03; 95% CI, 1.00–1.06, estimated by 10 percentage points of lower educational attainment) post adjusting for individual-level educational years, age, sex, income, residential years, disease, alcohol, smoking, social isolation, and population density. The association was significant in non-urban areas (HR, 1.05; 95% CI, 1.00–1.10). Conclusions:Older people living in communities with a higher prevalence of less educational attainment among their age demographic tended to develop dementia more often than those living in areas with a lower prevalence of less educational attainment after adjusting for individual-level educational attainment and covariates. In particular, the association was more pronounced in non-urban areas than in urban areas. Securing education for adolescence as a life course and population approach could thus be crucial to prevent dementia later in life among all older people living in non-urban areas.

scholarly journals Neighborhood sidewalk environment and incidence of dementia in older Japanese adults: the Japan Gerontological Evaluation Study cohort

2021 ◽  
Author(s):  
Yukako Tani ◽  
Masamichi Hanazato ◽  
Takeo Fujiwara ◽  
Norimichi Suzuki ◽  
Katsunori Kondo
Keyword(s):  
Urban Areas ◽  
Developed Countries ◽  
Evaluation Study ◽  
Community Dwelling ◽  
Grocery Stores ◽  
Study Cohort ◽  
Term Care ◽  
Residential Neighborhood ◽  
Incidence Of Dementia

Abstract Sidewalks are indispensable environmental resources for daily life in that they encourage physical activity. However, the percentage of sidewalks installation is low even in developed countries. We examined the association between neighborhood sidewalk environment and dementia in Japan. We conducted a 3-year follow-up (2010-2013) among participants in a Japan Gerontological Evaluation Study, a population-based cohort study of community-dwelling older adults. We ascertained the incidence of dementia for 76,053 participants from the public long-term care insurance system. We calculated sidewalk coverage (sidewalk area as a percentage of road area) within 436 residential neighborhood units using the geographic information system. Multilevel survival models were used to estimate hazard ratios (HR) for the incidence of dementia. During the follow-up, 5310 dementia cases were found. In urban areas, compared with the lowest quartile for sidewalk coverage, the HR was 0.42 (95% confidence interval (CI): 0.33–0.54) for the highest quartile, adjusting for individual covariates. After successive adjustments for other neighborhood factors (land slope, numbers of hospitals, grocery stores, parks, stations and bus stops, education level, and unemployment rate), the HR remained statistically significant (HR=0.75, 95% CI: 0.59–0.94). Living in neighborhoods with high sidewalks installation was associated with low dementia incidence in urban areas.

scholarly journals Social Participation and Functional Decline: A Comparative Study of Rural and Urban Older People, Using Japan Gerontological Evaluation Study Longitudinal Data

2020 ◽  
Vol 17 (2) ◽  
pp. 617 ◽  
Author(s):  
Kazushige Ide ◽  
Taishi Tsuji ◽  
Satoru Kanamori ◽  
Seungwon Jeong ◽  
Yuiko Nagamine ◽  
...  
Keyword(s):  
Longitudinal Data ◽  
Older People ◽  
Social Participation ◽  
Urban Areas ◽  
Proportional Hazards Model ◽  
Functional Decline ◽  
Evaluation Study ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Rural And Urban

This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.

scholarly journals Hepatitis E in Bangladesh: Insights from a National Serosurvey

2021 ◽  
Author(s):  
Andrew Azman ◽  
Kishor Kumar Paul ◽  
Taufiqur Rahman Bhuiyan ◽  
Aybuke Koyuncu ◽  
Henrik Salje ◽  
...  
Keyword(s):  
Urban Areas ◽  
Case Fatality ◽  
Population Level ◽  
Hepatitis E ◽  
Community Level ◽  
Reproductive Age ◽  
Serum Samples ◽  
Household Level ◽  
Individual Level ◽  
Geostatistical Models

Background Hepatitis E virus, typically genotypes 1 and 2, is a major cause of avoidable morbidity and mortality in South Asia. Although case fatality risk among pregnant women can reach as high as 25%, a lack of population-level disease burden data has been cited as a primary factor in key global policy recommendations against the routine use of licensed hepatitis E vaccines, one of the only effective tools available for preventing disease and death. Methods We tested serum from a nationally-representative serosurvey in Bangladesh for anti-HEV IgG. We estimated the proportion of the population with evidence of historical HEV infection and used Bayesian geostatistical models to generate high resolution national maps of seropositivity. We examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression. Results We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of hepatitis E of 20% (95% CI 17-24%). Seropositivity increased with age and male sex (OR: 2.2, 95% CI: 1.8-2.8). Community-level seroprevalence ranged from 0-78% with the seroprevalence in urban areas being higher, including Dhaka, the capital, with 3-fold (95%CrI 2.3-3.7) higher seroprevalence than the rest of the country. Conclusion Hepatitis E infections are common throughout Bangladesh, though 90% of women reach reproductive age without any evidence of previous exposure to the virus, thus likely susceptible to infection and disease. Strengthening clinical surveillance for hepatitis E, especially in urban areas may help generate additional evidence needed to appropriately target interventions like vaccines to the populations most likely to benefit.

scholarly journals PRECARITY AND LATER LIFE: UNDERSTANDING NEW INEQUALITIES AND RISKS IN LATER LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S588-S588
Author(s):  
Dale Dannefer ◽  
Christopher Phillipson ◽  
Dale Dannefer
Keyword(s):  
Older People ◽  
Life Course ◽  
Social Dynamics ◽  
Later Life ◽  
Academic Disciplines ◽  
Potential Contribution ◽  
Term Care ◽  
Economic Changes ◽  
Individual Level ◽  
The Life Course

Abstract This symposium addresses debates around the theme of precarity and its implications for understanding social and economic changes affecting the lives of older people. To date, the concept of precarity has been applied to several subpopulations by various academic disciplines but has yet to be systematically applied to later life. The symposium will give particular attention to the extent to which the lens provided by precarity can illuminate different types of inequalities experienced through the life course and reflected in public policies directed at older people. Chris Phillipson reviews theoretical perspectives relating to precarity, examining their potential contribution for the development of critical gerontology. His paper also considers the extent to which the concept of ‘precarious ageing’ offers a competing or complementary view to theories of ‘active’ and ‘successful ageing’. Larry Polivka examines the growing precarity of life for older Americans emanating from austerity budgets and privatization of public services. The paper suggests that policies such as health care and long term care are in jeopardy, creating a glide path toward the extension of precarious employment into a precarious retirement for millions of older people. Wenxuan Huang examines how the focus on agency and other individual-level foci obscure understanding of social dynamics. Finally, Amanda Grenier draws on a scoping review of precarity to outline conceptual distinctions between frailty, vulnerability, and precarity. She presents reflections on what these concepts offer in terms of understandings of late life the study of disadvantage across the life course.

scholarly journals Shelter/housing options, supports and interventions for older people experiencing homelessness

2021 ◽  
pp. 1-27
Author(s):  
Sarah L. Canham ◽  
Joe Humphries ◽  
Piper Moore ◽  
Victoria Burns ◽  
Atiya Mahmood
Keyword(s):  
Older People ◽  
English Language ◽  
Later Life ◽  
Supported Housing ◽  
Empirical Literature ◽  
Future Research ◽  
Term Care ◽  
Ageing In Place ◽  
Individual Level ◽  
Housing Options

Abstract While experiences of later-life homelessness are known to vary, classification of shelter, housing and service models that meet the diverse needs of older people with experiences of homelessness (OPEH) are limited. To address this gap, a scoping review was conducted of shelter/housing options, supports and interventions for OPEH. Fourteen databases were searched for English-language peer-reviewed and/or empirical literature published between 1999 and 2019, resulting in the inclusion of 22 sources. Through a collaborative, iterative process of reading, discussing and coding, data extracted from the studies were organised into six models: (1) long-term care, (2) permanent supportive housing (PSH), including PSH delivered through Housing First, (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach. Programme descriptions and OPEH outcomes are described and contribute to our understanding that multiple shelter/housing options are needed to support diverse OPEH. The categorised models are considered alongside existing ‘ageing in place’ research, which largely focuses on older adults who are housed. Through extending discussions of ageing in the ‘right’ place to diverse OPEH, additional considerations are offered. Future research should explore distinct sub-populations of OPEH and how individual-level supports for ageing in place must attend to mezzo- and macro-level systems and policies.

scholarly journals Hepatitis E in Bangladesh: Insights from a National Serosurvey

2021 ◽  
Author(s):  
Andrew S Azman ◽  
Kishor Kumar Paul ◽  
Taufiqur Rahman Bhuiyan ◽  
Aybüke Koyuncu ◽  
Henrik Salje ◽  
...  
Keyword(s):  
Urban Areas ◽  
Case Fatality ◽  
Population Level ◽  
Credible Interval ◽  
Hepatitis E ◽  
Community Level ◽  
Serum Samples ◽  
Household Level ◽  
Individual Level ◽  
Geostatistical Models

Abstract Background Hepatitis E virus, typically genotypes 1 and 2, is a major cause of avoidable morbidity and mortality in South Asia. Although case fatality risk among pregnant women can reach as high as 25%, a lack of population-level disease burden data has been cited as a primary factor in key global policy recommendations against the routine use of licensed hepatitis E vaccines, one of the only effective tools available for preventing disease and death. Methods We tested serum from a nationally-representative serosurvey in Bangladesh for anti-HEV IgG. We estimated the proportion of the population with evidence of historical HEV infection and used Bayesian geostatistical models to generate high-resolution national maps of seropositivity. We examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression. Results We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of hepatitis E of 20% (95% CI 17-24%). Seropositivity increased with age and male sex (Odds Ratio: 2.2 male vs. female, 95% Confidence Interval: 1.8–2.8). Community-level seroprevalence ranged from 0-78% with the seroprevalence in urban areas being higher, including Dhaka, the capital, with 3.0-fold (95% Credible Interval 2.3-3.7) higher seroprevalence than the rest of the country. Conclusion Hepatitis E infections are common throughout Bangladesh. Strengthening clinical surveillance for hepatitis E, especially in urban areas may help generate additional evidence needed to appropriately target interventions like vaccines to the populations most likely to benefit.

scholarly journals POSITIVE PSYCHOLOGICAL DETERMINANTS OF DEMENTIA IN JAPAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Kokoro Shirai ◽  
Kokoro Shirai ◽  
Hiroyasu Iso ◽  
Ryoto Sakaniwa ◽  
Katsunori Kondo
Keyword(s):  
Evaluation Study ◽  
Protective Role ◽  
Study Data ◽  
Community Dwelling ◽  
Term Care ◽  
Psychological Determinants ◽  
Cox Proportional Hazard ◽  
Dementia Incidence ◽  
Japanese Elderly ◽  
Long Term Care Insurance

Abstract We examined the effects of sustained levels of happiness on dementia incidence among Japanese elderly from the Japan Gerontological Evaluation Study. Data were from 12,051 community-dwelling participants aged 65 and over, free from dementia or other chronic conditions at baseline (2010). A survey was conducted in 31 administrative districts from Japan. Participants were followed-up for six years, and the incidence of dementia or death was assessed through National Public Long-Term Care Insurance and Resident Registry, Japan. We conducted survival analysis using the Cox proportional hazard model with a competing risk analysis accounting for death. The adjusted differences in days for dementia onset were estimated using Laplace regression models. In this analytical sample, we observed 520 men and 693 women with dementia and found that higher levels of sustained happiness were associated with reduced risks of onset of dementia among Japanese elderly. These findings suggest a protective role of psychological mood.

scholarly journals Association between community-level social capital and frailty onset among older adults: a multilevel longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

2021 ◽  
pp. jech-2021-217211
Author(s):  
Taiji Noguchi ◽  
Chiyoe Murata ◽  
Takahiro Hayashi ◽  
Ryota Watanabe ◽  
Masashige Saito ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Capital ◽  
Civic Participation ◽  
Health Behaviours ◽  
Evaluation Study ◽  
Community Level ◽  
Individual Level ◽  
Prospective Association ◽  
The Impact

BackgroundLittle is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data.MethodsThis prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan.ResultsIn total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants’ mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status.ConclusionsLiving in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.

scholarly journals Factors Associated with Falls in Community-Dwelling Older People with Focus on Participation in Sport Organizations: The Japan Gerontological Evaluation Study Project

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Takahiro Hayashi ◽  
Katsunori Kondo ◽  
Kayo Suzuki ◽  
Minoru Yamada ◽  
Daisuke Matsumoto
Keyword(s):  
Environmental Factors ◽  
Older People ◽  
Evaluation Study ◽  
Study Data ◽  
Community Dwelling ◽  
Sport Organizations ◽  
Term Care ◽  
Population Strategy ◽  
Community Dwelling Older People ◽  
Sport Organization

Objective.Promoting participation in sport organizations may be a population strategy for preventing falls in older people. In this study, we examined whether participation in sport organizations is associated with fewer falls in older people even after adjusting for multiple individual and environmental factors.Methods.We used the Japan Gerontological Evaluation Study data of 90,610 people (31 municipalities) who were not eligible for public long-term care. Logistic regression analysis was performed, with multiple falls over the past year as the dependent variable and participation in a sport organization as the independent variable, controlling for 13 factors. These included individual factors related to falls, such as age and sex, and environmental factors such as population density of the habitable area.Results.A total of 6,391 subjects (7.1%) had a history of multiple falls. Despite controlling for 13 variables, those who participated in a sport organization at least once a week were approximately ≥20% less likely to fall than those who did not participate at all (once a week; odds ratio = 0.82 and 95% confidence interval = 0.72–0.95).Conclusion.Participation in a sport organization at least once per week might help prevent falls in the community-dwelling older people.

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