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      Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study

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          Abstract

          Background

          The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias.

          Methods

          The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called ‘community salons’, providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument.

          Results

          In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74).

          Conclusions

          A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.

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          Most cited references17

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          Exercise, cognition, and the aging brain.

          We provide a brief review of the literature on exercise effects on brain and cognition. To this end, we focus on both prospective and retrospective human epidemiological studies that have examined the influence of exercise and physical activity on cognition and dementia. We then examine the relatively small set of human randomized clinical trials that have, for the most part, focused on exercise training effects on cognition. Next, we discuss animal research that has examined the molecular, cellular, and behavioral effects of exercise training. Finally, we conclude with a summary and brief discussion of important future directions of research on fitness cognition and brain.
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            Population based study of social and productive activities as predictors of survival among elderly Americans.

            To examine any association between social, productive, and physical activity and 13 year survival in older people. Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants' homes. Proportional hazards models were used to model survival from time of initial interview. City of New Haven, Connecticut, United States. 2761 men and women from a random population sample of 2812 people aged 65 and older. Mortality from all causes during 13 years of follow up. All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people.
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              Does social participation improve self-rated health in the older population? A quasi-experimental intervention study.

              Social participation has been linked to healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of 'salons' (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on self-rated health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for self-rated health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and self-rated health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in self-rated health over time. The odds ratio of participation in the salon programs for reporting excellent or good self-rated health in 2008 was 2.52 (95% CI 2.27-2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote healthy aging. Copyright © 2013 Elsevier Ltd. All rights reserved.

                Author and article information

                Journal
                J Epidemiol Community Health
                J Epidemiol Community Health
                jech
                jech
                Journal of Epidemiology and Community Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0143-005X
                1470-2738
                September 2015
                17 April 2015
                : 69
                : 9
                : 905-910
                Affiliations
                [1 ]Center for Preventive Medical Science, Chiba University , Chiba, Japan
                [2 ]School of Public Health, The University of Tokyo , Tokyo, Japan
                [3 ]Centor for Well-being and Society, Nihon Fukushi University , Nagoya, Japan
                [4 ]Department of International and Community Oral Health, Tohoku University Graduate School of Density , Sendai, Japan
                [5 ]Faculty of Rehabilitation and Care, Seijoh University , Tokai, Japan
                [6 ]Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health , Boston, Massachusetts, USA
                Author notes
                [Correspondence to ] Dr Hiroyuki Hikichi, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health,401 Park Drive, Landmark Center Room 403-T, Boston, MA 02215, USA; hikichi@ 123456hsph.harvard.edu
                Article
                jech-2014-205345
                10.1136/jech-2014-205345
                4552922
                25888596
                0861b984-604b-45f7-876d-aca1b45e51d4
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 5 December 2014
                : 5 March 2015
                : 26 March 2015
                Categories
                1506
                1507
                Other Topics
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                Public health
                ageing,disability,gerontology,health promotion,social activities
                Public health
                ageing, disability, gerontology, health promotion, social activities

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