社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

原著

An analysis of the relation between social interaction and healthy life
among the community-dwelling elderly in Japan
日本の地域高齢者における社会関係性と健康的な生活との関連構造
Shuo Wang1）, Suwen Yang1）, Fanlei Kong1）, Naoko Nakayama1）, Bin Ai2）, Tanji Hoshi1）王碩 1）、楊素Õ1）、孔凡磊 1）、中山直子 1）、艾斌 2）、星旦二 1）1）Graduate School of Urban Environmental Science, Tokyo Metropolitan University2）Department of Ethnology and Sociology, MinZu University of China
1）首都大学東京

都市環境科学研究科

2）中央民族大学

民族学与社会学学部

Abstract
Objectives: The purpose of this cohort study was to investigate age- and gender-related differences in the
structural relationship between social interaction and healthy life among urban elderly Japanese people aged
65-84. Methods: 7,904 elderly residents of Tama City were followed up for six years by using questionnaires andregisters obtained from city hall. Both bivariate correlation and structural equation modeling were utilized in theanalysis. Results: "Healthy life 2004" was positively and strongly associated with "social interaction 2001", "healthy
lifestyle 2004" and "physical function 2004". Moreover, besides direct effects, social interaction also demonstrated
indirect effects by means of healthy lifestyle and physical function. The maintenance of physical function wasdetermined to be particularly vital among older elderly and females, and the effects of a healthy lifestyle weremuch more pronounced in males than in females. The older elderly were found to be more influenced bysocial interaction levels than the younger elderly group. Conclusions: Healthy people should have the ability tosupervise others and to manage themselves, even at an advanced age. If changes are made in potential risk
factors, early prevention may be possible before functional disability, thus reducing the risk of mortality.
抄

録

目的：本研究の目的は、日本の都市部に住む 65-84 歳の高齢者における社会的関連性と健康的な生活の関係について、性・年齢別の違いを明らかにすることである。

方

法：多摩市の 7,904 人の高齢者について 6 年間追跡調査し、相関関係と構造方程式モデリングで分析した。

結果：主観的健康感と生存日数と関連する「健康的な生活 2004」（「」潜在変数を示す）は、「社会的関連性 2001」「健、康的なライフスタイル 2004」と「身体的な機能 2004」との関連構造が明らかになった。「健康的な生活
2004」は、「社会的関連性 2001」を基盤とする「健康的なライフスタイル」からの直接的な影響の他に、「身
体的な機能」を経由する間接的な効果が示された。「身体的な機能」から「健康的な生活 2004」への効果は、前期よりも後期高齢者で、男性よりも女性で強く関連していた。

結論：高齢者の健康長寿のためには、本人の健康を管理する能力がなければならない。もし制御要因を維持させるという早めの予防活動は、機能低下を予防し、生存を維持させることにつながる可能性がある。
Key words : social interaction; healthy lifestyle; physical function; healthy life; structural equation modeling.
キーワード: 社会的関連性; 健康的なライフスタイル; 身体的な機能; 健康的な生活; 構造方程式モデリング― 107 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

1．Introduction

evaluated in Japan, especially for the elderly people 20).

The final goal of "Health Japan 21" 1） , which

The strength of the influence of having social contact

provides l0-year national objectives for improving

and participation on mortality and longevity were

the health of all Japanese people since 2000, was toalso found in direct and indirect ways throughincrease quality and years of healthy life. Increasing

lifestyle 21） and functional status 22）, respectively.

healthy lifespan means more than just living longer –Murata et al. suggested group membership wasit also means having fewer unhealthy years. With asignificantly related to lower mortality among the

rapidly aging population in Japan, achieving a longer

old-old men (aged 75 and over) but not among womenand healthier life becomes increasingly significant.

in rural areas23）. After adjustment for lifestyle24） andAn extensive amount of literature has shown thatphysical function25）, the associations between social

self-rated health (SRH) accurately reflects the healthinteraction and mortality still existed. However, the2）status of older adults, including in Japan . In thiscovariant relationship, the underlying mechanism

study, a healthy life was defined as being able to live

and the process in which social interactions affect alonger with good SRH.

healthy life are still not well understood.

Healthy People 2010, proposed a systematic

In addition, social isolation and disengagement,

3）

approach to promote health on a national level .

which formed in the absence of social interaction andIn summary, healthy life could be influenced

participation, were associated with a higher risk ofby hereditary factors, the health-care system,

reporting one's health as being fair or poor26）. Tomás,

environmental factors, personal interactions, andGutiérrez, Sancho and Galiana maintained social

healthy lifestyles. Of these factors, the easiest for

relations had a positive impact on SRH for the young

people to control to live a healthy life were personalold, but these relations disappeared for the oldest

interactions and healthy lifestyles. However, theold27）.

elderly in general are distinguished from other

Identifying related factors of health and mortality

adult demographics by increased levels of physicalamong the elderly is important not only for theirfunctional decline4），5）, and this is of note because of

caregivers, but also for the whole country. Japanese

the associated increase in dependence, which is usedfemales have the highest life expectancy of 85.90

in examining long-term care degrees in Japan, andyears at birth in the world, which is 6.46 years

6）

longer than males28）. In Japan, the traditional view

because of its relation with mortality .
Social interaction plays an important part inof gender roles is that men should work outside

the daily life and well-being of elderly people. The

while women stay at home being a housewife: theassociation between social interaction and lower

differences in lifestyle are rather obvious. If age andmortality has been well observed in many western

gender differences are taken into consideration, it iscountries7），8），9），10），11）. However, Yasuda et al.

useful to inspect the related factors of healthy life,

recognized that such relations only observed inbecause the impact of predictors may vary betweenthesubgroups on the basis of gender and age, which few

75 years age group who lived in northeast

Baltimore, maybe due to functional decline with12）

studies have analyzed.

13）

age . Besides the direct effects , social interaction

Accordingly, this cohort study aims to: 1）

also affected mortality indirectly by its effects

investigate the structural relationship between social

14），15）and on one's physicalinteraction, healthy lifestyle, physical function, and. Furthermore, social interaction

healthy life among community-dwelling men and19）

women aged 65 to 84 in Japan over a six-year period;on a healthy lifestylefunctionality

16）
，17）
，18）

may serve different functions for men and women .

After the economic crisis, the interpersonal

2）determine age- and gender-related differences.

relationship crisis has emerged in recent years. Thus,
the importance of social interaction has been re-― 108 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

2．Methods
2.1

end of the follow-up survey, whichever was earlier.

Study subjects and data collection

Continued living and perception of oneself in goodTama City is a new city located in the western

health indicated a healthy life.

suburbs of Metropolitan Tokyo, developed in the late1960s. With young adults got older and older in forty

Social interaction

years, the elderly population had raised obviously.

Two levels, social contact and social participation,

The life expectancy of Tama (80.3 years for men, 86.5

were used to evaluate social interaction. Regarding

years for women) is a little bit higher than Tokyo (79.4

social contact, participants were required to describe

years for men, 85.7 years for women), and the long-the frequency of contact with their neighbors and29）

term care needs in Tama are the lowest in Tokyo .

friends. The responses were categorized as: noThis baseline survey enrolled all individuals, aged

contact at all; once a month; 3-4 times a week; and65 and over, living in Tama in September, 2001.

every day. As for social participation, leisure activity

13,195 individuals answered and mailed back theand volunteering asking: 'Did you take part in leisurequestionnaire, giving a response rate of 80.2%. A

activities in your area?' with 1 = No, 2 = Yes, andfollow-up survey was conducted in September 2004

'Were you involved with volunteering in your area?'by using the same questionnaire, and 8,558 respondedwith 1 = Regularly; 2 = Occasionally; and 3 = Not at

again. Of the 4,637 non-respondents, 505 had moved,all.

914 had passed away and 3,218 did not respond forother reasons. There was no statistical significance

Healthy lifestylein age and gender differences between participants

Healthy lifestyle was assessed with a healthy

and non-participants. Those aged 85 and over in 2001

dietary score and a healthy practice score. According

were excluded in order to minimize deviation, due

to Japanese surveys about dietary and lifestyleto their instability of data . Finally, the analyzed

habits by Hoshi31）, eight healthy dietary habits were

sample was 7,904, aged 65-84, who responded to

selected as follows: having meat and fish one to four

the first and second questionnaires. Dates of deathtimes per week; having bean products and salt-cured

were obtained from registers at the municipal hall,food more than five times per week; having milk,

including all deaths occurring between 1 September

dairy products, fruits and vegetables every day; and2004 and 31 August 2007. In order to facilitate

having fried food three to six times per week. Eachcomparisons, two subsamples were described byitem was assigned one point, and a person's healthy

age: 'younger elderly' (65-74 years) and 'older elderly'

dietary score was calculated as the sum total, with a(75-84 years). All the participants were provided withminimum of 0 points and a maximum of 8 points. A

informed consent forms, and all agreed.

higher score indicated a healthier dietary pattern.

30）

Similarly, a person's healthy practice score was
2.2

Measurements

defined to be the sum of the points assigned to

Healthy life

six factors, each with a point range of 0-6, those

People who lived a healthy life should havebeing: having breakfast every day; moderate alcohol

longevity in quantity and health in quality. In thisconsumption everyday (with a different pattern ofstudy, it was measured by survival time and thebinge drinking); having never smoked cigarettes; nocurrent self-rated health. A single question, 'How domore than nine hours of sleep every night; doing

you rate your state of health?' was asked in 2004,

physical activities no less than once a month; andwith a 4-point Likert scale response: 1 = Very Poor;

having a BMI of more than 21. A higher score

2 = Poor, 3 = Good; and 4 = Excellent. Survival

represented a more favorable health-promoting

time was calculated as the number of days from 1

practice pattern.

September 2004 to either the date of death or the― 109 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

2.4

Physical function

Statistical analysis

Two indicators were used to measure physicalTwo levels of analyses were performed.

function in 2004: basic activities of daily living

First, bivariate analysis was applied to examine(BADL) and instrumental activities of daily living

associations between the independent variables and(IADL). BADL was based on three items: toileting,healthy life, using SPSS 19.0 for Windows. Second,bathing, and going outside, which derived frommultivariate structural equation modeling was

32）

the Barthel Index of Activities of Daily Living .

performed to explain healthy life simultaneously

Individuals could gain one point if they could conduct

regarding all the independent variables, using

themselves without assistance, and no points were

Amos 17.0 for Windows. Statistical comparisonsassigned to those who needed help. The BADL scoreacross subgroups by the multi-group analyses

was calculated with three items, ranging in value

were supposed to examine the commonplaces andfrom 0 to 3. A higher score indicated better basic

disparate points among the research population. The

living competence. The IADL score was determined

goodness-of-fit was determined by Normalized Fit

by summing the points assigned to the following

Index (NFI), Incremental Fit Index (IFI), Root Mean

activities: purchasing daily goods; preparing daily

Square Error of Approximation (RMSEA), and chi-meals; making transactions at the bank; managing

square (CMIN). When NFI and IFI values were

one's pension and insurance; and reading newspapers

above 0.9, and RMSEA was less than 0.05, the model

33）

and books . The scores varied between 0 and 5

was considered to be an adequate one.

points, with higher scores indicating less dependence.
3．Results
2.3

3.1

Hypothesis

Bivariate relationships

In this study, the hypothesis were: 1）physicalAll the potential predictors were significantly

function had direct impacts on healthy life; socialand positively related to healthy life, indicating thatinteraction and healthy lifestyle demonstrated not

an increase in the value of independent variables

only direct impacts on healthy life of the elderly,

could lead to a longer and healthier life. But when

but also indirect effects by the means of physicalthe associations were presented in four age andfunction; 2）the underlying structural relationships

gender subgroups, some exceptions of no statisticalvaried among age and gender (Fig. 1).

significance appeared between survival time andcontact with neighbors and friends, leisure activity,
as well as in volunteering (Table 1).

Fig 1. Hypothesis of healthy life among the communitydwelling elderly in Japan.
[There are four latent variables. Arrows demonstrates
significant relationships and directions between
variables.]― 110 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

Table 1. Pearson correlation coefficients among independent variables and healthy life by age and gender

3.2

Structural analysis

function 2004; and healthy life 2004 (Fig. 2, 3). All the

For the SEM, four latent variables were applied:coefficients were significant under the regression co-social interaction 2001; healthy lifestyle 2004; physicalvariation (P<0.001). NFI was 0.984, IFI was 0.990,
and RMSEA was 0.011, which showed the model
fitted the observed data very well. Healthy life 2004
was determined by social interaction 2001, healthy
lifestyle 2004, and physical function 2004. For older
males, 84% of healthy life could be explained bysocial interaction, healthy lifestyle and physicalfunction (R2=0.84), 57% for younger males, 63% foryounger females and 93% for older females. The

Fig 2. Structural equation modeling of social interaction andhealthy life among older males.
[There are one latent exogenous variables (social
interaction 2001), three latent endogenous variables(healthy lifestyle 2004, physical function 2004, andhealthy life 2004) and 12 unobserved exogenous
residual error variables (d1- d3, e4- e9, z1- z3).
The models fitted the data reasonably well. The
Normalized Fit Index (NFI) and Incremental Fit
Index (IFI) exceeded the recommended valueof 0.9, whereas the Root Mean Square Error of
Approximation (RMSEA) was 0.011<0.05.]― 111 ―

Fig 3. Structural equation modeling of social interaction
and healthy life among younger females

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

Table 2. Standardized direct and indirect effects by age and gendermodel also showed social interaction 2001, healthy

The direct effects of social interaction on healthy life

lifestyle 2004 and physical function 2004 were

were more significant in older elderly (0.22 & 0.25)

positively and strongly related to healthy life 2004.

than younger elderly (0.15 & 0.15). Similar to direct

In addition, whether structural relationships wereeffects, the indirect (0.33 & 0.39) and total effects

direct or indirect were revealed: physical function(0.56 & 0.56) of social interaction on healthy life were

2004 had a direct impact on healthy life in the same

also more pronounced in older groups. Concerning

year; healthy lifestyle 2004 had not only a direct

healthy lifestyles, both the direct and total effects

effect on healthy life 2004, but also affected healthy

on healthy life were greater among males thanlife indirectly via physical function 2004; Social

females. In decreasing order, the standard regressioninteraction 2001 not only exerted direct effects on

coefficients of direct effects were 0.30 for younger

healthy life of the elderly, but also demonstrated anmales, 0.21 for older males, 0.15 for younger females,

indirect effect by the means of both healthy lifestyleand 0.13 for older females.

and physical function in 2004.
On the basis of age and gender, four elderly groups

4．Discussion

were compared with each other. The standard direct

B a s e d o n t h i s l a r g e - s c a l e c o h o r t s t u dy ofand indirect effects of social interactions, healthy

community-dwelling elderly in Japan, healthy life inlifestyles and physical functions on healthy life by age

2004 was well explained by social interaction in 2001,

and gender were shown in Table 2. With respect tohealthy lifestyle in 2004 and physical function in 2004.

direct effects, physical function exerted much more

In conjunction with other related factors of healthy

influence on healthy life among older elderly people

life, physical function exerted much more influence(0.68 for males and 0.80 for females) and females (0.72).

in accordance with the standard coefficient of total― 112 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

effects. In Nakazawa et al., an inverse relationshipwith each other on the basis of age and gender towas established between physical function levels

determine the similarity and dissimilarity. Allowing

and mortality in institutionalized elderly adults offor education which has related to disability andJapan6). In the present study, after adjusting for age,mortality, the consideration of the effects of socio-

gender, social interaction, and lifestyles, less physicaleconomic factors on healthy life are required inlimitation still could obviously decrease mortality

future studies.

risk among urban non-institutionalized elderly people

Social interaction served different functions forof Japan. As noted by Manton, higher mortality often

men and women, younger elderly and older elderly.

34）

With regard to standard total effect of physicaloccurs in disabled individuals .

Additionally, physical function in 2004 directly

function on healthy life, it was much greater in

affected healthy life in the same year, whereas social

older elderly groups than younger elderly groups,

interaction in 2001 and healthy lifestyle in 2004

and greater in females than males. In the viewexerted not only direct effects on healthy life in 2004,

of Sauvaget, Tsuji, Aonuma and Hisamichi, men

but also indirect impacts via physical function in

suffered disability at a younger age and died earlier,2004. This indicated that social interaction was thewhile women experienced a slow progress andbasis of the structure: high levels of interaction withlonger duration in a disabled state in Japan due tosociety could provide elderly people with access tolonger life expectancy36）. That is why maintenanceinformation about health and health-care services,of physical function is of capital importance for older

and chances to go outdoors into the life-space,elderly and females.

thus leading to a more favorable healthy lifestyle,

Regardless of standard direct, indirect or total

protecting against declining physical functionality,

effects, social interaction had the biggest impact on

and resulting in a healthy life. This finding confirmed

healthy life in older elderly groups. According to the'Activity Theory' raised by Robert J. Havighurst in'Disengagement Theory' raised by Blaine Cumming

the early 1960s, which outlined that successful aging

and William E. Henry in 1961, with an increase inoccurs when the elderly maintain social interaction

age, older adults may break away from society due

actively. Successful aging consist of not only health,

to a decline in ability and the loss of social roles: they

but also good relationships with society. Therefore,

do not have to deal with heavy housework or takepeople with high levels of interaction may live

care of grandchildren, leaving them with much more

longer, but this may not be directly due to positive

leisure time. Consequently, the older an individualinteraction but due to protective health behaviors

gets, the lonelier they would feel37）. This was why

and functional maintenance. The findings werethe effects were particularly noticeable in the older

35）

consistent with the conclusions found in Liu et al. .

elderly subgroup: they required more social contact

They suggested that socio-demographic factors (age,than the younger subgroup, to increase their social

gender and education), social relationships and healthinteraction level and help them build new social roles

behaviors associated with active life expectancy

for themselves. Furthermore, social participations

among elderly Japanese persons between 1987 andprovided elderly people much more chance going

1990. In spite of different indicators and survey

out. To some extent, it can promote their physicalperiods, similar conclusions were acquired among

exercises.

Japanese elderly people. However, their sample waslimited, just 1,671, over three years, and failed to

5．Conclusions

examine the co-variation and the extent to which

This study investigated the relationships betweensocial interactions may protect against death, failedsocial interaction, healthy lifestyle, physical function

to compare the age- and gender-related differences

and healthy life in Japanese community-dwellingas well. In this study, four subgroups were comparedelderly over a six-year period. Among these factors,― 113 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

social interaction was found to be the core: besides

disparity among the survey sample, also should bedirect effects, it also demonstrated indirect effects

considered and analyzed.

by means of healthy lifestyle and physical function,and indicated that high levels of social interaction

References

may lead to a more favorable lifestyle and improved1）The Ministry of Health, Labor and Welfare.

physical function, resulting in a healthy life. In

Annual Report on Health and Welfare 1998―

other words, social interaction may reduce the risk

1999. Social Security and National Life［retrievedof becoming disabled or dead. In fact, people who

on October 8, 2012］Retrieved from the Internet

interact with society actively can live longer, because〈http://www1.mhlw.go.jp/english/wp_5/vol1/

indirect effects of healthy lifestyle other than direct

p2c6s4.html〉

effects of social interaction. Functional limitation

2）L i a n g J , S h a w B A , B e n n e t t J M , K r a u s e

confers additional risk for death. Thus, death was

N, Kobayashi E, Fukaya T, Sugihara Y.

considered as a logical extension of limited physicalIntertwining courses of functional status andfunction. In summary, healthy people should havesubjective health among older Japanese. Journals

the ability to supervise others (active engagement inof Gerontology―Series B Psychological Sciences

society) and to manage themselves (high functioning),

and Social Sciences, 2007：62（5）：s340―s348

even at an advanced age. What's more, gender or3）U.S. Department of Health and Human Services.

age had only indirect effects. The maintenance of

Healthy People 2010. Boston: Jones and Bartlett

physical function was determined to be particularly

Publishers, 2000.

vital among older elderly and females, and the effects4）Bernard SL, Kincade JE, Konrad TR, Arcury

of a healthy lifestyle were much more pronounced in

TA, Rabiner DJ, Woomert A, DeFriese GH,

males than in females. The older elderly were foundOry MG. Predicting mortality from community

to be more influenced by social interaction levels

surveys of older adults: the importance of self-

than the younger elderly group. Health will be notrated functional ability. Journals of Gerontology.

perceived as something which should be protected,

Series B, Psychological Science and Social

but rather as something which could be produced,

Sciences, 1997；52（3）：s155-s163.

by active interactions and appropriate lifestyles.

5）Sawada Y, Shinohara R, Sugisawa Y, Anme

Accordingly, if changes are made in potential risk

T. The relation between the maintenance offactors, early prevention may be possible before

physical functions and social interaction among

functional disability, thus reducing the risk ofcommunity-dwelling elderly people: a six-year

mortality and the burden of caregivers.

follow-up study. Journal of physical therapy

Several distinguishing features of this study were:science, 2011；23（2）：171―175.

1）a long period and large-scale follow-up survey6）Nakazawa A, Nakamura K, Kitamura K,

provided a unique opportunity to explicate the

Yoshizawa Y. Association between activities ofstructure between social interaction and healthy life

daily living and mortality among institutionalized

among urban Japanese elderly; 2）it was found thatelderly adults in Japan. Journal of Epidemiology,changes in social interaction and lifestyle that lead to2012；22（6）：501―507.

a healthy life are feasible through individual efforts;

7）Al-Kandari YY. Relationship of strength of social

3）the results may be popularized to urban general

support and frequency of social contact withpopulations aged 65-84 due to the non-specifichypertension and general health status among

research population. Future study is needed to better

older adults in the mobile care unit in Kuwait.

understand among those aged 85 and over. As a next

Journal of Cross-Cultural Gerontology, 2011；26

step, the influence of socio-economic factors, such as
education and income, which would result in health― 114 ―

（2）：175―187.
8）Berkman LF. The role of social relations in社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

health promotion. Psychosomatic Medicine,18）Okun MA, August KJ, Rook KS, Newsom

1995；57（3）：245―254.

JT. Does volunteering moderate the relation

9）Berkman LF, Breslow L. Health and ways of

between functional limitations and mortality?

living: Findings from the Alameda country

Social Science & Medicine, 2010；71（9）：1662―

study, New York: Oxford University Press. 1983.

1668.

10）House J, Robbins C, Metzner H. The association

19）Avlund K, Damsgaard MT, Holstein BE. Socialof social relationships and activities withrelations and mortality. An eleven year follow-

mortality: prospective evidence from theup study of 70―year―old men and women in

Tecumseh Community Health Study. American

Denmark. Social Science & Medicine, 1998；47

Journal of Epidemiology, 1982；116（1）：123―40.

（5）：635―643.

11）Wolinsky FD, Johnson RL, Stump TE. The risk20）Murayama H, Shibui Y, Fukuda Y, Murashimaof mortality among older adults over an eight-

S. A new crisis in Japan-social isolation in oldyear period. Gerontologist, 1995；35（2）：150―

age. Journal of the American Geriatrics Society,2011；59(11）：2160―2162.

161.
12）Yasuda N, Zimmerman SI, Hawkes W, Fredman21）Hasegawa T, Hoshi T, Nakayama N, Bosako

L, Hebel JR, Magaziner J. Relation of social

Y, Takahashi T, Sakurai N, Tomoyama G,

network characteristics to 5-year mortality

Kurimori S, Yoshinori F. The effects of socio-

among young-old versus old-old white women in

economic status and lifestyle on life expectancy:

an urban community. Americana structural analysis of an elderly Japanese

Journal of

Epidemiology, 1997；145（6）：516―523.

population. International Medical Journal, 2011；18：261―264.

13）Unger JB, Johnson CA, Marks G. Functional
decline in the elderly: evidence for direct and22）Sugisawa H, Liang J, Liu X.. Social networks,

stress-buffering protective effects of socialsocial support, and mortality among older peopleinteractions and physical activity. Annals of

in Japan. Journal of Gerontology, 1994；49：S3―

Behavioral Medicine, 1997；19（2）：152―160.

S13.

14）Krijthe BP, Walter S, Newson RS, Hofman

23）Murata C, Takaaki K, Hori Y, Miyao D,A, Hunink MG, Tiemeier H. Is positive affectTamakoshi K, Yatsuya H, Sakakibara H,

associated with survival? A population-based

Toyoshima H. Effects of social relationships on

study of elderly persons. American Journal ofmortality among the elderly in a Japanese rural

Epidemiology, 2011；173（11）：1298―1307.

area: an 88-month follow-up study. Journal of
Epidemiology, 2005；15（3）：78―84.

15）Seeman TE. Health promoting effects of friends
and family on health outcomes in older adults.

24）Anme T, Shimada C. Social interaction andAmerican Journal of Health Promotion, 2000；14

mortality in a five year longitudinal study of the（6）：362―370.

elderly. Japanese Journal of Public Health, 2000；
47（2）：127―133.

16）Buchman AS, Boyle PA, Wilson RS, Fleischman
DA, Leurgans S, Bennett DA. Association25）Anme T, Shinohara R, Sugisawa Y, Itoh S.

between late-life social activity and motor

Social interaction and mortality: a seven-year

decline in older adults. Archives of Internallongitudinal study of elderly people. Japanese

Medicine, 2009；169：1139―1146.

Journal of Public Health, 2006；53（9）：681―687.

17）Lyyra TM, Leskinen E, Heikkinen E. A cohort26）Coyle CE, Dugan E. Social isolation, lonelinessstudy found good respiratory, sensory and motor

and health among older adults. Journal of Aging

functions decreased mortality risk in older

and Health, 2012；24（8）：1346―1363.

people. Journal of Clinical Epidemiology, 2005；27）Tomás JM, Gutiérrez M, Sancho P, Galiana

58: 509―516.

L. Predicting perceived health in Angolan― 115 ―

社会医学研究．第 30 巻 2 号．Bulletin of Social Medicine, Vol.30（2）2013

elderly: the moderator effect of being oldest old.

Health-life expectancy according to various

Archives of Gerontology and Geriatrics, 2012；

functional levels. Journal of the American55（3）：605―610.

Geriatrics Society, 1999；47（11）：1326―1331.

28）Ministry of Internal Affairs and Communications.

37）Shi RH. The senile mental health reading.

Statistical Handbook of Japan 2012,［retrieved

Shanghai: Shanghai Scientific and Technologicalon November 10, 2012］Retrieved from the

Literature Publishing House. 1996.

Internet〈http://www.stat.go.jp/english/data/handbook/index.htm〉
29）Ministry of Health, Labor and Welfare. Overview
of the life table by city in 2005.［retrieved on
October 8, 2012］Retrieved from the Internet〈http://www.mhlw.go.jp/toukei/saikin/hw/life/
ckts05/index.html〉
30）Hoshi T. Chronological evaluation of physical,
psychological and social health of urban elderly
dwellers over 6 years and assessment of causal
inter-relationships. Japanese Journal of Public
Health, 2011；58（7）：491―500. (in Japanese).
31）Hoshi T. The causal relationships between
meaning of life and healthy life expectancy inthree years among elderly urban dwellers ofJapan. Healthy and Active Aging. Center ofSocial Development Longevity. Japan: Chuohoki
Publishing Co. Ltd. 2012.
32）Mahoney FI, Barthel DW. Functional Evaluation:
the Barthel Index. Maryland state medical
Journal, 1965；14：61―65.
33）Koyano W, Shibata H, Nakazato K, Haga H,
Suyama Y. Measurement of competence:
Reliability and validity of the TMIG index
of competence. Archives of Gerontology andGeriatrics, 1991；13（2）：103―116.
34）Manton KG. "Mortality and Morbidity" In
Robert H. Binstock and Linda K. George (Eds.),
Handbook of Aging and the Social Sciences (3rded.) San Diego, CA: Academic Press. 1990.
35）Liu X, Liang J, Muramatsu N, Sugisawa H.
Transitions in functional status and active
life expectancy among older people in Japan.
Journals of Gerontology. Series B, Psychological
Science and Social Sciences, 1995；50（6）：s383―
s394.
36）Sauvaget C, Tsuji I, Aonuma T, Hisamichi S.

― 116 ―