Uemura Kazuki, Kamitani Tsukasa, Nagai Koutatsu, Ueda Tetsuya, Kuzuya Masafumi, Yamada Minoru
Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan.
Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan.
Prev Med. 2025 Jul;196:108294. doi: 10.1016/j.ypmed.2025.108294. Epub 2025 May 9.
Loss of independence (LOI) significantly affects quality of life and increases societal costs. Community gathering places supported by local governments aim to prevent LOI. However, evidence of their effectiveness among older adults with mild disability is limited. We investigated whether participation in community gathering places reduces the risk of LOI among older adults, including those with mild disability.
This retrospective cohort study used data from the Public Survey of Long-Term Care Prevention in Habikino City, Japan. The study was conducted from January 2020 to January 2024 and included 1961 adults aged ≥65 years without care needs. Participation in community gathering places was assessed at baseline, and LOI (new certification of need for long-term care, or death) was followed for four years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs), with adjustment for demographics and health conditions. We also performed a subgroup analysis to assess the potential effect modification of mild disability (support levels 1-2 under Japan's Long-Term Care Insurance system).
Participants in community gathering places had a significantly lower risk of LOI than non-participants (adjusted HR 0.57, 95 % CI 0.36 0.90). Subgroup analyses showed that older adults with mild disability benefited similarly, with no effect modification (P for interaction = 0.22).
Participation in community gathering places appeared to reduce the risk of LOI across different functional levels. These findings support initiatives to promote such environments and emphasize the role of social engagement in aging policies.
失去独立能力（LOI）会显著影响生活质量并增加社会成本。由地方政府支持的社区聚集场所旨在预防失去独立能力。然而，其在轻度残疾老年人中的有效性证据有限。我们调查了参与社区聚集场所是否能降低老年人（包括轻度残疾者）失去独立能力的风险。
这项回顾性队列研究使用了日本羽曳野市长期护理预防公众调查的数据。研究于2020年1月至2024年1月进行，纳入了1961名年龄≥65岁且无护理需求的成年人。在基线时评估参与社区聚集场所的情况，并对失去独立能力（长期护理需求新认证或死亡）进行了四年的随访。使用Cox比例风险模型估计风险比（HRs）和95%置信区间（CIs），并对人口统计学和健康状况进行了调整。我们还进行了亚组分析，以评估轻度残疾（根据日本长期护理保险系统的支持水平1 - 2）的潜在效应修正。
参与社区聚集场所的参与者失去独立能力的风险显著低于未参与者（调整后的HR为0.57，95% CI为0.36至0.90）。亚组分析表明，轻度残疾的老年人也有类似的受益，且无效应修正（交互作用P = 0.22）。
参与社区聚集场所似乎能降低不同功能水平下失去独立能力的风险。这些发现支持促进此类环境的举措，并强调了社会参与在老龄化政策中的作用。
