Hidehiro Sugisawa

Religion, social support, and health among the Japanese elderly.

We address three issues in this paper: (1) Is religion related to self-rated health, (2) do these salubrious effects arise because religion encourages people to provide help to significant others, and (3) is the relationship between religion and helping others more evident among older men than elderly women? We analyze the relationships among religion, support giving, and health with data provided by a national probability sample of 2,153 older people in Japan who were interviewed face-to-face in 1996. Greater involvement in religion is associated with providing help to others more often, but these effects emerge for older men only. Regardless of gender, elders who provide assistance to others more often rate their health more favorably than older adults who are less involved in helping others. These results confirm that religion is related to health, and that helping others may explain at least part of the reason for this relationship.

Trends in Old-Age Functioning and Disability in Japan: 1993-2002

Disability is a burden to individuals and society. Population ageing, combined with the fact that disability is most common among the elderly, has focused attention on trends in old-age disability. This study estimates trends in functioning and disability among Japanese elderly from 1993 to 2002 and contrasts the patterns with those found in the USA. Japan is an especially interesting country because its age structure is relatively old, and it currently has the highest life expectancy in the world despite the fact that just 50 years ago its life expectancy was in the bottom half of all countries. As in the USA, disability rates have fallen. If it were not for the gains in disability between 1993 and 2002, there would have been 1.1 million more disabled elderly in 2002. The reductions were experienced broadly across socio-demographic and economic groups. Increases in education across cohorts are associated with the declines in disability.

Changes in Functional Status Among Older Adults in Japan: Successful and Usual Aging.

This research aimed to chart the trajectories of functional status in old age in Japan and to assess how self-rated health and cognitive functioning differentiate these trajectories and account for interpersonal differences. Data came from a 5-wave panel study of a national sample of 2,200 Japanese older adults between 1987 and 1999. The sample as a whole showed an accelerated increase in functional limitations with age. approximated by a quadratic function. More important, 3 major trajectories of functional change were identified: (a) minimal functional decrement, (b) early onset of functional impairment. and (c) late onset of functional impairment. These findings may serve as useful benchmarks for observations derived from other developed nations.

Gender differences in old age mortality: Roles of health behavior and baseline health status

This research aims to further current understanding of gender differences in old age mortality. In particular, it assesses the relative importance of health behavior and baseline health conditions in predicting the risk of dying, and how their effects differ between elderly men and women. Data for this research came from a prospective study of a national sample of 2,200 older adults in Japan from 1987 to 1999. Hazard rate models were employed to ascertain the interaction effects involving gender and health behavior (i.e., smoking and drinking) and baseline health status. Gender differences in old age mortality in the Japanese are quite pronounced throughout all of our models. In addition, interaction effects of gender and smoking, functional limitation, and cognitive impairment, indicate that females in Japan suffer more from these risk factors than do their male counterparts. Failure to adjust for population heterogeneity may lead to a significant underestimation of female advantage in survival. The inclusion of health behavior and health status measures only offsets a limited proportion of this gender differential. The increased mortality risk due to smoking, functional limitation, and cognitive impairment among elderly Japanese women suggests that narrowing of gender gap in mortality may be due to not only changes in the levels of these risk factors but also their differential effects on men and women.

The Impact of Social Ties on Depressive Symptoms in U.S. and Japanese Elderly

This study examines the effects of social ties (with spouse, children, friends, neighbors, other relatives, and community groups) on depressive symptom levels in U.S. and Japanese adults aged 60 and over. Nationally representative survey data from the United States (N= 1,419) and Japan (N= 2,200) indicate that having a spouse, or increased contacts with friends, neighbors and relatives was associated with fewer depressive symptoms in both samples. The effects of spousal presence were significantly larger in the United States than in Japan. The presence of children was associated with fewer depressive symptoms in Japan only, and this effect was significantly stronger among those currently unmarried as opposed to those who are currently married. We discuss these similarities and differences between countries.

A longitudinal study of coping and burnout among Japanese family caregivers of frail elders

Objectives: The purpose of this study is to clarify causal relations between coping strategies and burnout in family caregivers of frail elders in Japan. Methods: Baseline and 1-year follow-up interviews were conducted with 546 caregivers living in suburban Tokyo. Using newly refined measures, five coping strategies of caregivers (Keeping Their Own Pace, Positive Acceptance of Caregiving Role, Diversion, Informal Support Seeking, and Formal Support Seeking), and caregiver burnout were measured, as well as several confounding factors. Results: After controlling for these confounding factors, results of cross-lagged effects modelling showed that adoption of a Diversion coping strategy decreased caregiver burnout, while increases in burnout decreased caregiver Positive Acceptance of Caregiving Role. Conclusions: The beneficial effect of an Adaptive Avoidance Coping strategy, Diversion, on caregiver mental health was confirmed in this two-wave longitudinal study. The mechanism by which Diversion appears to work is by containing caregiving stressors from completely spilling over into caregivers’ personal lives. In addition, we also show that preventing a decline in caregiver mental health (i.e. an increase in burnout) allowed caregivers to more easily embrace the caregiving role and, as a result, elder care-recipients were better positioned to receive high quality care.

Functional capacity in elderly Japanese living in the community

The present addresses concepts, definitions, and measurements of functional capacity. Further, distributions of functional capacity are assessed by such various indices as activities of daily living (ADL), instrumental ADL (IADL), the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, and active life expectancy in the Japanese elderly. Further, predictors of functional status are demonstrated, and the impact of functional decline on quality of life is investigated in elderly Japanese living in the community.

Gender differences in health among the Japanese elderly.

Evidence has emerged recently to challenge the widely held notion that women experience more physical health problems than men. The purpose of this study is to re-evaluate this issue with a broad range of health measures gathered in a culturally diverse population--older adults in Japan. Taken as a whole, the findings suggest that there are gender differences in health. However, patterns of female excess in morbidity depend upon the type of health status measure that is examined. In particular, the data reveal that elderly women experience more functional disability and rate their overall health less favorably than older men. In contrast, a consistent pattern of gender differences in health fail to emerge when specific acute and chronic health problems are evaluated.

Psychosocial mediators between socioeconomic status and dietary habits among Japanese older adults.

Introduction: ObjectivesThe purpose of this study was to examine psychosocial mediators between socioeconomic status (SES) and eating habits in older Japanese adults.Subjects and methodsA questionnaire was mailed to a representative sample of people who were 60 years and older (N=1,000) living in a suburban area within the Tokyo city metropolitan limits, in Japan. There were 552 effective participants in the study.DesignDietary habits were evaluated by assessing the diversity of food that was consumed. SES was evaluated by educational attainment and household income. Four dimensions of psychosocial mediators were assessed: control expectancy, self-efficacy, social influence, and social support. Indirect effects of SES through the mediators were evaluated by using a multiple mediator model.ResultsThe relationship between education and dietary habits was mediated by three variables excluding social support. Especially, social influence had the strongest mediating effect. These three significant variables explained the majority of differences in dietary habits resulting from education. The effects of household income were also similarly mediated by the identical variables.ConclusionControl expectancy, self-efficacy, and social influence mediate the relationship between SES and dietary habits.

Factors in Mental Health Problems among Japanese Dialysis Patients Living in Heavily Damaged Prefectures Two Years after the Great East Japan Earthquake

This study examined the prevalence of mental health problems and related factors among dialysis patients living in prefectures that were heavily damaged by the Great East Japan Earthquake. Research was conducted two years following the disaster, and data of 1500 residents of the prefectures were analyzed. This study examined disaster related stressors, gender, socioeconomic status, health problems prior the earthquake, and social support, all of which have been identified as aggravating/mitigating factors in previous research on disaster survivors. We also examined advanced awareness of emergency planning as a dialysis specific factor. Mental health problems after the disaster were categorized into three types: PTSD and depression comorbidity, PTSD only, and depression only. Results indicated that people with comorbidity, PTSD, and depression comprised 7.5%, 25.0%, and 2.9% of the sample, respectively. Not only disaster related stressors but also health problems prior to the disaster had an aggravating direct effect on comorbidity and PTSD. In addition, social support and advanced awareness of disaster planning had a mitigating effect on comorbidity. These results suggest that advanced awareness of disaster planning is a dialysis specific factor that could decrease the occurrence of comorbidity among dialysis patients following a disaster.