The Effect of Social Integration on Self-Rated Health for Elderly Japanese People: A Longitudinal Study1

INTRODUCTIONIn Japan, ever-larger numbers of elderly people are surviving to ever-older ages while the numbers of children and grandchildren to care for them have shrunk. Because Japan has publicly funded universal health care, public concern has arisen over how to postpone permanent disability and to promote healthy aging. In Japan, the public concern over the capacity of younger generations to take care of the elderly has led to a gradual ideological shift of responsibility from solely family-based care to include community-based services created by new welfare policies (Campbell, 2000; Hiroi, 2006: Hirano, 2005). In the process of such transition, various self-advocacy groups, including People First, shed light on the civil rights of people with disability (Hayashi and Okuhira, 2001). Increasing public awareness is observed through the media, politics, and law addressing people with disability in respectful ways (Gottleib, 2001). As the aging of Japan proceeds, the expansion of the culturally assigned responsibility for eldercarc to include the public sector has invited research on how to postpone disability and promote healthy aging. Healthy elders can promote economic well-being in their families and their nations by being caregivers to their oldest-old relatives and active participants in community development.Two alternative perspectives have been advanced to explain how social integration in later life, as represented by someone's activity in multiple social roles, might affect health and the timing of death. (Multiple roles is a concept isomorphic with status set (Moen et al., 1989), defined as behavior that fulfills multiple positions under responsibility, expectations, and rights.) According to the role strain perspective, the occupancy of multiple roles can hasten the onset of chronic disease, disability, or death if it creates competing demands that produce overload and stress (Barnett, Marshall and Pleck, 1992; Kandel, Davies and Raveis, 1985; Voydanoff and Donnelly, 1 999). On the other hand, the role enhancement perspective argues that engaging in multiple roles can lead to higher levels of physical and emotional health than having fewer roles, because the accumulation of social identities or roles enhances individual resources, social connections, prestige, emotional gratification, and social identity (Barnett and Marshall, 2001; Chrouser and Ryff, 2006; Moen et al., 1989; Wethington et al., 2000). Individuals with diverse social roles can fall back on another relationship if they encounter difficulties in a particular role (Chrouser and Ryff, 2006; Kikuzawa,2000).In Japan, although the average size of the family and the proportion of three-generational households have been declining in the period since the Second World War (Figure 1 ), it is still more common for Japanese elders to co-reside with children and/or grandchildren than is true in most other industrialized nations, including the United States (U.S.). It is often believed that cultural norms derived from the idea of Confucianism that emphasize the importance of respecting the elderly define multigenerational households as an ideal type of household for the elderly to avoid social isolation. However, hidden behind the image of togetherness in the harmonious extended family portrayed in television programs, movies, and magazines, various scholars pointed out the stress experienced by the elderly and the family caregiver (Hashimoto and Traphagan, 2004; Traphagan, 2008), In addition, although the proportion of the elderly living in three-generational households in Japan is still higher than in Western countries, "siipu no samenai kyori" (indicating a distance which does not allow the soup to get cold) became a popularized metaphor as an ideal form of family-based support for the elderly (Kweon, 1997). Since the 1980s, such a new form of two household family homes, nisetai jutaku, became a popular option to reduce the tension observed in three generational households (Brown, 2003). …