Objectives This study aimed to assess the living situation and health of elderly people in an urban area of Japan at risk of becoming homebound, so as to tailor measures to prevent or delay this occurring. We identified the prevalence rate of people currently homebound and those at risk, classifying using predictors reported in previous studies. An assessment of physical and cognitive factors affecting each classified group was included.
Methods The survey targeted 149,991 people aged 65 or older living in Setagaya Ward in Tokyo. Mail-in questionnaires included items to assess respondents' demographic characteristics, physical and mental health conditions, quality of life, activities of daily living, and social lifestyles. We operationally defined people who go out (leave their home) only two or three times a week as the “at-risk” group, and “homebound“ was defined as going out only once a week or less. Then we determined the prevalence rates of the homebound and at-risk group. We sub-classified the at-risk group by conducting a cluster analysis using predictors of homebound status reported in previous studies. Then we identified each group's characteristics by comparing mental health and cognitive condition between the groups.
Results Questionnaire responses from those who did not fill out the survey themselves or who failed to fully answer questions on homebound predictors used in the cluster analysis were excluded. Also disregarded were responses from hospital inpatients or residents of elderly care facilities. The final number of respondents included in the analysis was 90,605. The prevalence rate of elderly who were at risk of becoming homebound was found to be 13.0% (n=11,282). Cluster analysis identified five clusters based on instrumental ability of daily living, mental health and cognitive condition: very good condition (46.4%), depressive (23.5%), low cognitive function and depressive (19.6%), low Instrumental Activities of Daily Living (IADL) (6.5%) and very poor condition (3.8%). The very good condition group fared favorably in nearly all aspects assessed in the questionnaire. The depressive group and the low cognitive function and depressive group strongly indicated anxieties about falling or about their future life and included people who went out less frequently compared with the previous year. The low IADL group and the very poor condition group were comparatively old and included a high percentage of people registered as requiring long-term care.
Conclusion Based on the particular characteristics of the identified groups, we propose primary strategies to help elderly people who are at risk of becoming homebound: 1) Very good condition group: Identify reasons why their frequency of outings is just two or three times a week, even though they seem to be healthy, and provide assistance with maintaining their current health condition considering those reasons. 2) Depressive group: Prevent physical decline by providing consultations addressing their anxieties about falling. 3) Low cognitive function and depressive group: Intervene in the early stages to address negative cognitive states such as loneliness. 4) Low IADL group: Intervene to help maintain their remaining abilities including cognitive function. 5) Very poor condition group: Ensure maintenance of services or support currently being provided, and have community health care providers and staff monitor health status changes.

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Objectives The purpose of this study was to examine the sociodemographic and health-related characteristics of those who are unaware of the Japanese Food Guide Spinning Top (Food Guide).
Methods A longitudinal study was conducted using an Internet-based questionnaire with 1,012 Japanese adults (40.2±10.0 years, mean±SD) recruited from registrants of a Japanese social research company. Conducted between November 2007 (T1) and December 2008 (T2), the survey included items on awareness level (“I know the contents.” “I have heard of this Guide.” or “I have not heard of this Guide.”) of the Food Guide as the dependent variable, and demographics factors (e.g., age, education status, marital status, household income, and employment status) and health-related characteristics (obesity, abdominal obesity, and insufficient physical activity) as the independent variables. Multivariate logistic regression analysis was used to analyze the relation between awareness level and each variable. The relation between change of awareness level (T1–T2) and each variable was analyzed using a chi-square test. All the analyses were stratified by gender.
Results In the multivariate logistic regression analysis adjusted for all variables, men with a household income of 5,000,000–10,000,000 yen (OR=1.78; 95% CI=1.10–2.88) were positively associated with awareness level (“I have heard of this Guide.”). In contrast, unmarried women were negatively associated with awareness level in T1 (“I know the contents”; OR=0.35; 95% CI=0.17–0.70. “I have heard of this Guide”; OR=0.50; 95% CI=0.27–0.92). In men, the awareness level of the Food Guide increased from T1 to T2, change of awareness level (T1; “I have not heard of this Guide”) and education status being related (P=0.023). In women, the awareness levels overall did not improve from T1 to T2, but change of awareness level (T1; “I have heard of this Guide”) was associated with household income (P<0.001). In both men and women, change of awareness level was not associated with health-related characteristics.
Conclusion The results of this study suggest that awareness of the Food Guide has increased among those with health risk factors, such as obesity and low levels of physical activity. The promotion strategy of the Food Guide might need to target males with low-level education, unmarried women, and women with a high household income.

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[in Japanese]

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Objectives This study sought to clarify changes in both Sense of Coherence (SOC) and social support during one year and causal relationships among upper-grade elementary school children.
Methods A one-year longitudinal survey using a self-rating questionnaire containing measures regarding individual attributes, SOC, and social support was conducted for all 403 pupils from 4th to 6th grade at a public elementary school in a suburban area of Kanagawa prefecture. Latent growth curve analysis was carried out on 237 pupils who completed all three surveys, conducted once in each semester. Firstly, to observe both overall and individual changes in SOC and social support scores, a model was constructed for each score, using the score for each semester as an observable variable, intercept (signifying the score of the first semester) and slope (signifying change of score during a year) as latent variables, and grade and sex as independent variables. Then, models of both were combined to examine causal relationships.
Results For change in SOC score, the mean slope was 0.01 (n.s.) with a variance of 2.85 (P<.05). Thus the score had no change overall, but there were pupils whose scores gradually rose or fell during the year. For change in social support score, the mean slope was −1.25 (P<.05) and its variance was 8.47 (P<.01). Therefore, the score showed an overall decrease, but there were pupils whose scores gradually rose. Grade and sex were not related to change in either score. The intercept of the social support score contributed to the slope of the SOC score (0.44, P<.001), and the intercept of the SOC score contributed to the slope of the social support score (0.34 P<0.05). Thus, a high score of social support in the first semester raised the SOC scores in the following second and third semesters, and a high score of SOC in the first semester raised subsequent social support scores. Grade and sex were not related to these associations.
Conclusion Among 237 upper-grade elementary school children, it was found that SOC overall demonstrated no change and social support decreased over one year. Pupils whose social support was abundant in the first semester had heightened SOC subsequently, and high levels of SOC in the first semester increased social support thereafter. Therefore, it was suggested that an interactive causal relationship between SOC and social support could be demonstrated by latent growth curve analysis.

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