This study aimed to identify factors associated with continued attendance in independent group activities following completion of a positive psychology-based depression prevention program, called “Happy Classroom”. The program, called “Happy Classroom,” has been run for many years in two Japanese municipalities located in Tokyo and Kanagawa Prefecture, after completion, graduates are encouraged to independently run and participate in group activities. Focus group interviews were conducted with regularly attending members of three such groups, which had been active for different lengths after finishing the classes. Several aspects of the activities were associated with continued participation: friendly uninhibited relationships with other attendees, reliable leaders, venue accessibility, democratic management style, support from related organizations, and expanded sense of community. These factors indicate that when considering their involvement with such independent group activities, governments and related institutions should recognize the value of cultivating friendly and uninhibited relationships among group members, while closely safeguarding their self-directed nature. To ensure group members continue to attend activities in the long term, it also seems crucial to develop activities intended to heighten attendees’ awareness of and connection with their community．

Factors related to the worry about utilizing medical and long-term care services among older adults, especially those living alone, were investigated. A postal survey was conducted with older adults（n = 3,956）that were randomly selected from residents aged 65 and over in a city in Tokyo（response rate = 68.2%）. The results indicated that approximately 30% of older adults were worried about the use of medical and long-term care services. The following factors were associated with their worry about medical and long-term care services: being a woman, having a younger age, living alone, a low annual income, lack of instrumental support from family members, low social cohesion in the neighborhood, low self-rated health, and high depressive feelings. The factors related to worry were generally common, regardless of whether they lived alone or not. The results of structural equation analyses showed that older adults living alone tended not only to lack the support of their family members but also to have less social cohesion, and therefore, they had a higher depressive mood and worry. It is suggested that more research is necessary on networking, which could provide the support required by older adults living alone.

This research examined the effect of using preventive service in the long-term care insurance system on the basis of two outcome indicators. The subjects comprised 2791 elderly people who had recently been certified as being eligible for support［levels 1 and 2］between 2012 and 2014 in a suburb of Tokyo, and the occurrence of each event by 2016 was observed. Therefore, in the "one or more levels of decline of eligibility level" indicator, the use of the service increased the risk of an event occurring（HR 1.30, 95% CI: 1.17–1.45）. However, with the "mortality" indicator, the use of the service decreased the risk（HR 0.65, 95% CI: 0.52–0.80）. Furthermore, in "one or more levels of decline of eligibility level," it became clear that if an event were to occur relatively early, the range of decline would be small. A small decline of eligibility level detected at an early stage may preclude a serious change for the worse and have the effect of decreasing the risk of mortality. Considering such a positive effect, this event should be evaluated carefully.

This study analyzed the effects of motor function and cognitive function on self-perceived fatigue among older worker. Participants were 157 members（133 men and 24 women）of the Silver Human Resources Center in “A” City, Tokyo, who were in charge of outdoor work（weeding and park cleaning）, aged 63-86 years（mean age: 74.2 ± 5.3 years）. The following variables were measured: self-perceived fatigue, motor function, cognitive function, age, sleep duration, air temperature during working hours, physical activity and job control.

It was suggested that motor function and cognitive function were not significantly related to change self-perceived fatigue, but interaction term between both functions was significantly related to change of self-perceived fatigue.（β=-0.07, p=0.004）. Fatigue management methods should be developed to functioning of older workers.

[Objective] In order to make quantitative estimates that long-term care services could be substituted by informal care and others in near future. [Method] We conducted a questionnaire survey anonymously according to the Delphi method for caremanagers. The survey included work locations, background qualifications, and the expected alternative rates of current public long-term care insurance services. [Result] 90 people volunteered for the survey (response rate 75.6%). The rate at which substitution is expected to be possible was the highest at 26.4% for home-care services, and the rates for day-care and night-time home-care services increased, especially after the discussion. Facility care was considered to be 19.4–20.7% alternative. The expectations for IT (information technology) and robots were safety confirmation, recreation, exercise, and so on. The expected replacement rate did not differ by care managersʼ age, gender, work location, and background qualification. [Conclusion] The possibility of substitution by informal care was expected greatly in visiting care and outpatient care.

Aim: The purpose of this study was to examine social isolation among community-dwelling elderly people with exercise habits, and the factors that could lead to a change in their experience of social isolation.

Method: The 118 subjects all participated in radio calisthenics and lived in a community. We investigated the effect of social isolation using the shortened version of the Lubben Social Network Scale. Participants were asked to complete a stressful life event questionnaire. Semi-structured interviews were conducted with seven people who had experienced a change in their social isolation status to investigate the causes of the change.

Results: First, 14 subjects experienced social isolation（11.9%）. Second, social isolation was common when stressful life events had occurred close to the survey period. Factors that led to social isolation – “refusing to be intimate with others” and “progressively less social contact with aging” – and factors that prevented isolation – “participation in voluntary group activities” and “adapting to environmental changes” – were extracted.

Conclusion: The results suggest that psychological factors due to stressful life events may temporarily reduce contact with others and lead to social isolation, but over time and with participation in voluntary group activities many are able to escape from isolation.

Echo intensity（EI）of skeletal muscle obtained by ultrasonography is considered to reflect muscle quality. This study aimed to compare lower-limb muscle quantity, quality, and physical function between independent older adults and those certified for long-term care and/or support.

A total of 98 older adults participated in this study, and then 40 were independent group, whereas 58 were certified group. Muscle thickness（MT）, subcutaneous fat thickness（FT）, and EI of the right front-thigh were evaluated using ultrasonography imaging method. Six physical functions were measured by tests including knee extension strength, and fitness age score（FAS）was calculated from the values obtained.

In both sexes, independent group had significantly higher MT and lower EI than certified group. All physical functions in independent group were significantly higher than those in certified group. When multiple regression analysis was performed, after adjusting sex, group, age, body mass index, and FT, MT and EI were still significantly correlated with knee extension strength. However, EI was not significantly correlated with FAS. This study indicates that lower-limb muscle quantity is more strongly associated with physical functions than muscle quality in older people.