GCOE Discussion Paper Series
Global COE Program

Human Behavior and Socioeconomic Dynamics
Discussion Paper No. 304

Towards an Age-Friendly City: The Constraints
Preventing the Elderly’s Participation in Community
Programs in Akita City

Yoshihiko Kadoya

April 2013

GCOE Secretariat
Graduate School of Economics

OSAKA UNIVERSITY

1-7 Machikaneyama, Toyonaka, Osaka, 560-0043, Japan

Towards an Age-Friendly City: The Constraints
Preventing the Elderly’s Participation in Community
Programs in Akita City*

Yoshihiko Kadoya†

Abstract
The inclusion of the elderly in community life is a major factor in achieving an age-friendly
city. However, there has been little research investigating the constraints preventing theelderly’s interaction with society. With that in mind, this paper is pioneering the investigationof such constraints using the results from the “Questionnaire towards an Age-Friendly City”
by Akita City Government in Japan, a member of the World Health Organization (WHO)’s
Global Network of Age-friendly Cities and Communities. This paper reveals two policy
implications. First, living with someone encourages elderly to interact with society. Second,the elderly’s ability to be mobile fosters their social participation.
Key words: age-friendly city, aging, elderly’s social participation, community programs,
isolation*

This research used micro data from the “Questionnaire towards an Age-Friendly City” by Akita City
Government. I acknowledge the survey contributors at the government. I thank Charles Yuji Horioka,
Shizuka Sekita, Midori Wakabayashi, Wataru Kureishi, Mari Kan, and the other seminar participants at
Osaka University, Japan.
†
Graduate School of Economics, Nagoya University, Furo-cho, Chikusa, Nagoya 466-8601, Japan.
Phone: +81-52-789-2367 Email: yoshi.kadoya@soec.nagoya-u.ac.jp

Introduction“Promoting the elderly’s inclusion in and contribution to all areas of community life” is oneof the six pillars of active aging (World Health Organization [WHO], 2007). Much of theresearch endorses this statement, encouraging the elderly to interact with others byparticipating in local community programs, such as sports/cultural events, local festivals, orcommunity-building activities. In reality, many elderly individuals are reluctant to interact
with others and therefore remain lonely (Victor et al., 2000; Findlay, 2003; Gardner et al.,
1999; Edelbrock et al., 2001). In this paper, we intend to uncover the constraints preventing
the elderly’s participation in community programs by investigating the results of the“Questionnaire towards an Age-Friendly City” by Akita City Government in Japan, which
has one of the country’s highest rates of people aged 65 and over.
In the literature on ageing, social isolation has been defined in different ways. For
example, Cattan and White (1998) employed both objective and subjective measures: an
objective measure of social interaction and a subjective expression of dissatisfaction with asmall number of social contracts. Hall and Havens (2001) and Van Baarsen et al. (2001) also
used this combined concept. Gardner et al. (1999), however, only employed an objective
definition. They defined people as socially isolated if they had poor or limited contact withothers and they perceived this level of contact as inadequate and/or that the limited contact
had adverse personal consequences for them. People who only had poor or limited social
contact were considered “at risk” of social isolation, though some people prefer to be aloneand suffer no adverse effects regarding their quality of life.
Regardless of people’s preferences, most research indicates that social interaction isvery beneficial for the health and wellbeing of older people (Bower, 1997; Fratiglioni, 2000;
Moyer et al., 1999; Pennington, 1992; Victor et al., 2000; Wenger et al., 1996). For people
aged 65 and older, social isolation has been linked with increased mortality rates (Bower,1997); elevated blood pressure (Bower, 1997); increased propensity for dementia (Fratiglioni,
2000); rural stress (Monk, 2000); depression (Gutzmann, 2000; Silveira & Allebeck, 2001);
and suicide (Center for Disease Control and Prevention, 1996; Conwell, 1997; Rapagnani,
2002).
In reality, social isolation has become a serious problem. The population is aging,which means that more people are living alone (WHO, 2007). Of course, many governments
and international organizations are attempting to deal with this issue. A notable example isthe development of a framework for age-friendly cities initiated by the WHO, which statesthat “Promoting the elderly’s inclusion in and contribution to all areas of community life” isone of the six pillars of active aging. The WHO also established the WHO Global Network ofAge-friendly Cities and Communities (GNAFCC) to spread best practices in select cities andcommunities. Yet, social isolation amongst older people has still emerged as one of the major
issues facing the industrialized world.
Nonetheless, there has been little research investigating the constraints preventing theelderly’s interaction with society. Although much of the research claims that social isolation
increases health risks, the opposite is also true; some individuals are isolated because they areill. It is unreasonable to claim that an elderly person’s poor health is due to a lack of social
interaction because, for example, those who are bedridden or those who suffer from severe
dementia often simply cannot interact with others. Therefore, in order to identify theconstraints preventing the elderly’s interaction with society, health factors that are difficult tomeasure must be excluded.
In this research, we therefore pioneer the investigation of the constraints preventing theelderly’s interaction with society, focusing on participation in community programs. Using
data about Akita City, excluding health status factors, we identify these constraints for the
first time and reveal policy implications in order to help achieve the “elderly’s inclusion inand contribution to all areas of community life.”
Analyzing the Case of Akita City
As mentioned, we have used the results of “Questionnaire towards an Age-Friendly
City”. Akita City is the capital of Akita Prefecture, located in the northeastern part of Japan.
As of April, 2012, the city’s population stands at approximately 320,700.
Investigating the case of Akita is important for two reasons. First, Akita is at theforefront of the issue. The ratio of the population aged 65 or over in the total population,
hereafter referred to as the population aging rate, in Akita City was approximately 24% in2012. It is estimated that the rate will reach 34.2% by 2040 (Age-friendly World, 2012). As
seen in Figure 1, the average population aging rate in the more developed regions is expected
to catch up with the rate in Akita City by 2040. Akita City is among the frontrunners in termsof the population aging rate. Thus, Mayor Hozumi pledged to make the city age-friendly
when he was elected in 2009. Since then, the city has made significant strides, for example,
by becoming a member of GNAFCC and soliciting residents’ opinions via the “Questionnaire
towards an Age-Friendly City.”
Figure 1. World’s Population Aging Rate (%)
40
35
30
world

25
20

More developed
regions

15

Akita

10
5
0
2010 2015 2020 2025 2030 2035 2040 2045 2050
Source: United Nations (2010)
Note: More developed regions, as defined by the United Nations (2010), comprise all regions of Europe plus
North America, Australia/New Zealand, and Japan.

Second, analyzing the data from the questionnaire allows us to identify policy
implications. The purpose of this research is to identify the constraints preventing theelderly’s interaction with society that can help keep them healthy. In reality, it is very difficult
to differentiate “social interaction” from “long-term care.” For instance, many people providecare to elderly individuals who are bedridden. However, such interaction is not necessarily“social interaction.” That is, all elderly people who reside in either hospitals or nursing homes
would have “interaction” if we include such care in the term “social interaction.” Apart from
that, it may not be reasonable for governments to encourage such elderly individuals toengage in any social interaction as those who are bedridden probably either cannot do it or do
not want it. Therefore, it is necessary to exclude those who require care (i.e., those who areincapable of the activities of daily living [ADLs]) from this analysis. With this in mind, the
Akita survey succeeded in collecting data only from those who are at least capable ofperforming ADLs. That is, Akita City distributed the questionnaire to those who do not hold a“care grade” in Japan’s Long-Term Care Insurance (LTCI) system. The LTCI is a universal
system through which elderly people can receive necessary long-term care services in Japan.
In order for the elderly to receive long-term care services, their need for physical andpsychological care must be measured objectively at a public institution and categorizedaccording to “care grade.” A person who is capable of ADLs is disqualified from theminimum care grade level, which is “Care 1” (see Table 1).

Table 1. Approximate standards of the minimum care grade, Care 1
OverallStanding

Standing

andExcretion

EatingDaily

Symptoms ofAbnormalup/keep

routines

Decreasing

Behavior

movingstandingsuch as nailComprehension

on footon acutting andsingle legchanging
clothes

Needs partial

Needs

Needs

care

some

occasionallyassistance

CapableCapableNeeds

Can beseen

somepartialocasionallyassistanceassistanceCan be seen
occasionallyoccasionallySource: Niigata City (2008)

Akita City is forward thinking in terms of the aging population ratio and collects datafrom those who are capable of ADLs. It is therefore important to study the data to identify theconstraints preventing the elderly’s social participation that can help them stay healthy.

Methods
Data
Akita City’s “Questionnaire towards an Age-Friendly City” was distributed andcollected in the period from July 7–30, 2010. The target population was city residents aged 65
or over who are not at the care-grade level. The sample was randomly selected based on the
Basic Resident Register. The survey was sent via the mail, and the return rate was 77.3%. The
reason for such a high return rate may be because the respondents expect the government toconsider their answers when creating social policy. From the dataset, we selected 1,141

respondents that had no missing answers.
Definition of Social Interaction
Focusing on community programs, we use the variables shown in Table 2. We assess the
respondents’ level of social interaction using the following criteria: 1) whether he/she has
participated in any local community activities (e.g., sports/cultural events, local festivals, orcommunity-building activities) in the last year; 2) whether he/she is willing to interact withyoung people; and 3) whether he/she often (or sometimes) participates in any local non-profit
organization (NPO)/volunteer activities. As for the variable “suburb,” we define the Kawabe
or Yuwa areas of the city as suburbs because both areas were previously towns adjacent to
Akita City until they came under the same municipality in 2005.
Table 2. Variables and description
Variable

Description(1) activity_d

Have you participated in any local community activity (e.g.,sports/cultural events, local festivals, or community-building
activities) in the last one year? (1=Yes, 0=No)(2) youth_d

Are you willing to interact with young people? (1=Yes, 0=No)(3) npo_d

Do you often (or sometimes) participate in any local NPO activity?
(1=Yes, 0=No)

Sex

1=Male, 0=Female

Age

Medium value of the following choices (65–69 years old, 70–74
years old, 75–79 years old, 80–84 years old, 85 years old or over)Solo

1=live alone, 0=others

Suburb1=live in former Kawabe town/ Yuwa town, 0=otherwiseCar

1=drive a car, 0=otherwiseWork

1=have a job, 0=otherwise

Sfarmer

1= farmer/self-employed, 0=otherwise

The descriptive statistics for the variables are shown in Table 3. The average age of the
respondents is 73.6. Of the respondents, 14% live alone and 86% live with their families;
41% drive a car; 19% have a job; and more than half are either farmers or are self-employed.
The models used in this research are as follows.
(1) Prob (activity_d = 1) = a + b (Sex) + c (Age) + d (Solo) + e (Suburb) + f (Suburb*Car) +g (Work) + h (Work*Sfarmer)(2) Prob (youth_d = 1) = a + b (Sex) + c (Age) + d (Solo) + e (Suburb) + f (Suburb*Car) + g(Work) + h (Work*Sfarmer)(3) Prob (npo_d = 1) = a + b (Sex) + c (Age) + d (Solo) + e (Suburb) + f (Suburb*Car) + g(Work) + h (Work*Sfarmer)
Table 3. Descriptive statistics
Mean

Sd.

Max.

Min.

Obs.

(1) Activity_d

0.5393457

0.49867

0

1

1131

(2) youth_d

0.311229

0.4632011

0

1

1131

(3) npo_d0.1007958

0.3011913

0

1

1131

Sex

0.4341291

0.4958613

0

1

1131

Age

73.56941

5.858909

67

87

1131

Solo

0.1414677

0.3486576

0

1

1131

Suburb

0.0654288

0.2473904

0

1

1131

Car

0.4076039

0.4916062

0

1

1131

Work

0.193634

0.3953202

0

1

1131

Sfarmer

0.1016799

0.3023606

0

1

1131

Table 4 shows the estimation results with three major findings. First, living solo may
influence the elderly’s social interaction. In Models 1 and 3, the variable “solo” issignificantly negative. Those who live solo are unlikely to participate in local community
programs and NPO activities compared to those who live with someone. Second, the elderly’s
mobility affects their social interaction. In Models 1 and 2, the variable “car” is positive andsignificant. Those who can drive a car are more active in participating in local community
activities and interacting with young people. In addition the interaction term “suburb*car” isnot significant. Being capable of driving a car is effective not just in rural area. Third, holdinga job appears to encourage the elderly to interact with young people. The work dummy issignificantly positive in Model 2. Those who have a job tend to be more willing to interact
with young people, though this is not necessarily the case regarding participating in local
community and NPO activities. This may be because those who have a job get used tointeracting with young people through their job. However, this could be due to the notion thatthose who like to interact with young people tend to continue working in their old age.

Table 4. Estimation results(1)(2)
activity_d
youth_d-0.01890.0428(-0.20)(0.43)(3)
npo_d0.272**(2.16)

age-0.0134*(-1.89)-0.00281(-0.38)-0.00799(-0.80)solo-0.191*(-1.73)0.0470(0.41)-0.355**(-1.97)suburb

0.115(0.56)

0.0890(0.41)-0.0814(-0.26)car

0.300***(2.90)

0.262**(2.45)

0.00628(0.05)

suburb_car

0.542(1.64)

0.0274(0.09)-0.653(-1.18)work-0.123(-0.89)0.339**(2.47)

0.210(1.24)

work_sfarmer

0.00654(0.04)-0.205(-1.17)-0.256(-1.14)

_cons

1.000
(1.89)
1131-0.478(-0.86)1131-0.788(-1.06)
1131

sex

N
t statistics in parentheses*

p < 0.10, ** p < 0.05, *** p < 0.01

Results
In attempting to identify the constraints preventing the elderly from participating incommunity programs, this research reveals two policy implications. First, the governments
need to take particular note of the elderly who live alone. As this research revealed, livingwith someone else is an important factor encouraging the elderly to participate in social
activities. Those who live alone are likely to require a support, not just because they do nothave anyone who offers a help at home, but also because they are less likely to connect to the
local community. Implementing a regular visit to the elderly who live alone and/or
encouraging them to enter a nursing home may prevent them from possible social isolation.
Second, the governments may need to enhance the elderly’s mobility that greatly fosters theirsocial participation. In reality it is not easy to encourage an elderly person to drive a car due
to the safety matter, but developing public transportation would be the substitute. For
example, increasing the number of community buses would help the city to be age-friendly interms of including the elderly in community life.

Conclusions
The inclusion of the elderly in community life is a major factor in achieving an
age-friendly city. However, there has been little research investigating the constraints
preventing the elderly’s interaction with society. With that in mind, this paper is pioneering
the investigation of such constraints using the results from the “Questionnaire towards an
Age-Friendly City” by Akita City Government in Japan, a member of the World HealthOrganization (WHO)’s Global Network of Age-friendly Cities and Communities. This paper
reveals two policy implications. First, living with someone encourages elderly to interact withsociety. Second, the elderly’s ability to be mobile fosters their social participation.
This research has yet several weaknesses due to data constraints. First, the detailed

household status was unknown for the respondents. Although many elderly live alone, someof them might or might not have a relative next door. The absence of such information could
possibly distort the results. Second, this research included no economic variables. To be
active in society, a certain level of wealth may be necessary, but this research could notconsider this aspect because that data was not available.
Nonetheless, this paper contributes significantly to the study of the elderly’s inclusion
in community life, which is a major component of an age-friendly city. Although little
research has analyzed the constraints preventing the elderly’s social interaction due to data
limitations, this pioneering paper identifies at least some of the constraints, which include
household status and mobility. With that in mind, this research can help to improve the healthand wellbeing of elderly individuals in our society and can help in creating more age-friendly
cities.

References
Age-friendly World. (2012). Age-friendly world: Adding life to years. Retrieved fromhttp://www.agefriendlyworld.org/city/akita
Bower, B. (1997). Social links may counter health risks: research on how social isolation
affects mortality in older adults. Science News, 152, 9–135.
Cattan, M. & White, M. (1998). Developing evidence-based health promotion for older
people: a systematic review and survey of health promotion interventions targetingsocial isolation and loneliness among older people. Internet Journal of Health
Promotion. Retrieved from http://rhpeo.net/ijhp-articles/1998/13/index.htm
Center for Disease Control and Prevention. (1996). Suicide among older persons: UnitedStates 1980–1992. Journal of the American Medical Association, 275(7), 509.
Conwell, Y. (1997). Management of suicidal behavior in the elderly. Psychiatric Clinics ofNorth America, 20(3), 667–683.
Edelbrock, D., Buys, I., Creasey, H., & Broe, G. A. (2001). Social support social networks
and social isolation: the Sydney older persons’ study. Australian Journal on Ageing, 20,4173–4178.
Findlay, A. R. (2003). Interventions to reduce social isolation amongst older people: where is
the evidence? Aging & Society, 23, 647–658.
Fratiglioni, L. (2000). Influence of social network on a occurrence of dementia: acommunity-based longitudinal study. The Lancet, 355, 1315–1320.
Gardner, I., Brooke, E., Ozanne, E., & Kendig, H. (1999). Improving social networks, aresearch report: Improving health and social isolation in the Australian veterancommunity. Melbourne: Lincoln Gerontology Centre, La Trobe University.
Gutzmann, H. (2000). Diagnosis and therapy of depression in advanced age. Therapeutische
Umschau, 57(2), 95–99.
Hall, M. & Havens, B. (2001). The effects of social isolation and loneliness on the health ofolder women. Research Bulletin, Centers of Excellence for Women’s Health, 2(2), 6–7.
Monk, A. (2000). The influence of isolation on stress and suicide in rural areas: aninternational comparison. Rural Society, 10(3), 393–403.
Moyer, A., Coristine, M., MacLean, L., & Meyer, M. (1999). A model for building collective
capacity in community-based programs: the ‘Elderly In Need Project,’ Public HealthNursing, 16(3), 205–214.
Niigata City. (2008). Kaigo hoken saabisu gaido (Long-term care insurance service guide).
Niigata, Japan.
Pennington, D. C. (1992). Essential Social Psychology. London: Hodder and Stoughton.
Rapagnani, G. (2002). Suicide in the elderly. Revue Medicale de Liege, 57(2), 91–96.
Silveira, E. and Allebeck, P. (2001). Migration, ageing and mental health: an ethnographic
study on perceptions of life satisfaction, anxiety and depression in older Somali men ineast London. International Journal of Social Welfare, 10(4), 309–320.
UnitedNations.

(2010).

World

Population

Prospects.

Retrievedfrom

http://esa.un.org/wpp/unpp/panel_population.htm
Van Baarsen, B., Snjiders, T.A., Smit, J. H., & Van Dujin, A. J. (2001). Lonely but not alone:emotional isolation and social isolation as two distinct dimensions of loneliness in older
people. Educational and Psychological Measurement, 61(1), 119–136.
Victor, C., Scambler, S., Bond, J., & Bowling, A. (2000). Being alone in later life: loneliness,social isolation and living alone. Reviews in Clinical Gerontology, 10, 407–417.
Wenger, C., Davies, R., Shahtahmasebi, S., & Scott, A. (1996). Social isolation and lonelinessin old age: review and model refinement. Aging and Society, 15(3), 333–358.
WHO.

(2007).

Globalage-friendly

cities:aguide.

Retrieved

http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf

from