The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.

Living arrangements of older adults have changed worldwide with increasing solitary and non-spouse households, which could affect social care systems. However, the relationship between these households and disability onset has remained unclear. We examined the relationship between living arrangements and the onset of basic activities of daily living disability in older adults, with a focus on gender differences and cohabitation status of those without a spouse. Data from 6600 men and 6868 women aged 65 years or older without disability were obtained from the Aichi Gerontological Evaluation Study Project in Japan. Onset of disability was followed for 9.4 years. Disability was assessed based on Long-term Care Insurance System registration. A hierarchical Cox proportional hazards model was conducted to examine the risk of living alone and living only with non-spousal cohabitants compared to those living with spouses. Men living only with non-spousal cohabitants and those living alone were significantly more likely to develop disability after controlling for health and other covariates (hazard ratio = 1.38 and 1.45, respectively), while a significant difference was found only for women living alone (hazard ratio = 1.19). The risk of living with non-spousal cohabitants was marginally stronger in men, indicated by the interaction effect model (p = .08). A series of hierarchical analyses showed that social support exchange explained 24.4% and 15.8% of the excess risk of disability onset in men living alone and those living only with non-spousal cohabitants, respectively. A subsequent analysis also showed that support provision by older adults more greatly explained such excess risk than receiving support from others. Older men without spouses were more likely to develop disability onset regardless of cohabitants. Health professionals should consider programs that enhance social support exchange, particularly support provision by older adults who are at risk of disability.

Social support is important for the health of elderly populations. However, its longitudinal effect on incident dementia is unclear. We used the Aichi Gerontological Evaluation Study (AGES) project data to investigate the longitudinal effect of social support on dementia onset. Functionally independent older people at baseline (n = 14,088) in 10 municipalities were followed from 2003 to 2013 using National Long-term Care Insurance System data. Social support was assessed by the following support sources: co-residing family, family or relatives living apart, and friends or neighbors. Cumulative incidence of dementia was 14.6% and 18.7% for men and women, respectively. Cox proportional hazard models were employed by gender to investigate the association between social support and dementia onset adjusting for age, health status, health behaviors, subjective cognitive complaints, depression, and other socioeconomic factors. Gender differences were observed in the association between social support and incident dementia. Support from co-residing family members was protective among men, whereas among women, no effect of social support on dementia was observed. Among other social factors, community engagement was protective for women, while for men, being married was associated with lower incidence of dementia. The association between social support and dementia seems to differ by gender. When we design programs to promote social interactions among the elderly, we need to take into account such gender differences.

In Asian nations, family ties are considered important. However, it is not clear what happens among older people with no such ties. To investigate the association, we used longitudinal data from the Aichi Gerontological Evaluation Study (AGES) project. Functionally independent older people at baseline (N = 14,088) in 10 municipalities were followed from 2003 to 2013. Social ties were assessed by asking about their social support exchange with family, relatives, friends, or neighbors. Cox proportional hazard models were employed to investigate the association between social ties and the onset of functional disability adjusting for age, health status, and living arrangement. We found that social ties with co-residing family members, and those with friends or neighbors, independently protected functional health with hazard ratios of 0.81 and 0.85 among men. Among women, ties with friend or neighbors had a stronger effect on health compared to their male counterparts with a hazard ratio of 0.89. The fact that social ties with friends or neighbors are associated with a lower risk of functional decline, independent of family support, serves to underscore the importance of promoting social ties, especially among those lacking family ties.

We examined the association between objective and perceived neighborhood characteristics and self-reported leisure-time physical activity (PA) in older Japanese residents living in areas ranging from metropolitan to rural in 2016. Objective measures used were walkability and the numbers of parks/green spaces and sports facilities within 500 or 1000 m of subjects’ homes, calculated using geographic information systems. Subjective measures were the subjects’ perceptions of their neighborhoods, assessed using a structured questionnaire. All variables were divided into three groups, and the lowest tertile was used as the reference. We assessed the location and frequency of strolling or brisk walking, moderate-intensity PA, and vigorous-intensity PA (sports) using a self-reported questionnaire and defined as performing a certain type of PA 3–4 times/week as a habit. Living in a neighborhood in the highest tertile for walkability and number of parks/green spaces as well as perception of having good access to recreational facilities, observing others exercising and the presence of walkable sidewalks was associated with walking and sports habits (multivariable odds ratios (ORs): 1.33–2.46, all p < 0.05). Interestingly, objective measures of PA-friendly environmental features were inversely associated with moderate-intensity PA habits, potentially because moderate-intensity PA consisted predominantly of gardening. In conclusion, living in an environment supportive of PA, whether objectively or subjectively measured, is related to leisure-time PA habits among older Japanese adults.

Positive affect and incident dementia among the old