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Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study
  1. Hiroyuki Hikichi1,6,
  2. Naoki Kondo2,
  3. Katsunori Kondo1,3,
  4. Jun Aida4,
  5. Tokunori Takeda5,
  6. Ichiro Kawachi6
  1. 1Center for Preventive Medical Science, Chiba University, Chiba, Japan
  2. 2School of Public Health, The University of Tokyo, Tokyo, Japan
  3. 3Centor for Well-being and Society, Nihon Fukushi University, Nagoya, Japan
  4. 4Department of International and Community Oral Health, Tohoku University Graduate School of Density, Sendai, Japan
  5. 5Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan
  6. 6Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Hiroyuki Hikichi, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health,401 Park Drive, Landmark Center Room 403-T, Boston, MA 02215, USA; hikichi{at}


Background The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias.

Methods The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called ‘community salons’, providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument.

Results In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74).

Conclusions A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.

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