Objectives Lower socio‐economic status (SES) may be associated with dementia later in life, but there is inconsistent evidence supporting this claim. We aim to examine the association between three SESs (education, job, and income indicators) and dementia onset in older adults. Methods Study design was a 6‐year prospective cohort study. Participants included a total of 52 063 community‐dwelling adults aged 65 years or older without long‐term care needs from the Japan Gerontological Evaluation Study. Outcome variable was dementia onset. Explanatory variables were educational years, the longest job held, and equivalised household income. We performed Cox proportional hazard analysis by gender with multiple imputation. Results During the follow‐up period, 10.5% of participants acquired dementia. The adjusted risks of dementia incidence of the participants with less than 6 years of education were 1.34 times (95% confidence interval [CI], 1.04‐1.73) in men and 1.21 (1.00‐1.45) times in women higher than those with more than 13 years of education. Females with less than 1.99 million yen (hazard ratio = 0.83, 0.72‐0.96) of equivalised income were less likely to acquire dementia than those with four million yen or higher. Conclusions Educational attainment had a robust impact on dementia onset compared with the other SES factors in both genders of older Japanese people. Securing an education for children could be crucial to prevent dementia later in life. The longest job held was less likely to be risks of dementia incidence, compared with the other two factors.
Background As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. Methods We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1–87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01–1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02–1.13), there was no association in urban areas (HR: 1.03; 0.99–1.06). Conclusions Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.
Introduction:The Ministry of Health, Labor, and Welfare of Japan have suggested local governments establish Health, Medical, and Welfare Coordination Headquarters at the time of disaster. Gathering and processing information is one of the key functions of the headquarters. The study aims to clarify the required functions of information for the headquarters.Method:A series of interview surveys and observations were conducted, including for local governments and experts in disaster response. The contents were analyzed and required standard functions and procedures had been extracted.Results:The most important aspect of information gathering is its use in decision-making in matching needs and demands with resources. Needs and demands are based on damage and situation of the casualties. Resources can be categorized into human, material, financial, and informational. Because the headquarters have to process much information, it is important to clarify the objective and strategy of disaster response. The headquarters gather various quantitative and qualitative information using information and communication technology, telephone, meeting and other methods. Qualitative information can be categorized as: expected, surprising (unexpected), and unusual (rare) contents. For expected contents, quantification or estimation of needs from information in normal time or limited information immediately after the disaster and displaying or further analyzing by geographic information systems is useful. By surprising contents or case reports, additional responses or strategies will need to be reviewed.Conclusion:The procedure, including information gathering and decision-making, follows the OODA (observe, orient, decide, act) loop. According to our mail survey of all 47 prefectural local governments in 2019, 89% were planning to establish the headquarters. However, only 36% had prepared a manual. Using the results of this study, a standard strategic manual for the operations of the headquarters is being developed and brushed up.
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