title: 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.
abstract: 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.
authors.affiliation: Center for Preventive Medical Science, Chiba University, Chiba, Japan Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikichi
authors.affiliation: School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kondo
authors.affiliation: Center for Preventive Medical Science, Chiba University, Chiba, Japan Centor for Well-being and Society, Nihon Fukushi University, Nagoya, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Department of International and Community Oral Health, Tohoku University Graduate School of Density, Sendai, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Aida
authors.affiliation: Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan.
authors.forename: Tokunori
authors.initials: T
authors.lastname: Takeda
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D019058:Community Networks / Q000458:organization & administration*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D057216:Propensity Score; D016016:Proportional Hazards Models; D058992:Social Participation; D011795:Surveys and Questionnaires
keywords: AGEING; DISABILITY; GERONTOLOGY; HEALTH PROMOTION; Social activities