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. 2023 Sep 23;36:102443. doi: 10.1016/j.pmedr.2023.102443

Types and frequency of social participation and comprehensive frailty among community-dwelling older people in Japan

Nanako Saeki 1, Mayumi Mizutani 1,⁎, Susumu Tanimura 1, Ritsuko Nishide 1
PMCID: PMC10656264  PMID: 38021414

Abstract

Although research has established social participation as important for preventing frailty in older people, the association between the type and frequency of social participation and comprehensive frailty remains unclear. This study aimed to reveal the associations between types and frequency of social participation and comprehensive frailty among community-dwelling older people. This was a cross-sectional study conducted in four cities and towns (Inabe City, Nabari City, Odai Town, and Kiho Town) of Mie Prefecture, Japan, among adults who were: (i) aged ≥65 years and (ii) not certified as needing long-term care. We measured comprehensive frailty using the participants’ total scores on the Kihon Checklist, developed by Ministry of Health, Labour and Welfare of Japan, which divides frailty status into three categories: robust (0–3 points), prefrail (4–7), and frail (8–25). Types and frequency of social participation were explanatory variables, and ordered logistic regression analysis adjusted for potential confounding factors identified the associations. The frailty status of the 296 participants (age 65–74 years: 44.3 %; female: 74.0 %) was as follows: frail, 21.3 %; prefrail, 40.2 %; and robust, 38.5 %. Lower level of frailty was associated with interaction using smartphones 2–3 times per month, participating in sports ≥4 times per week, participating in local improvement activities several times per year, and engaging in activities for children 2–4 times per month. Social participation among older adults at appropriate frequencies were associated with the lower level of comprehensive frailty. However, future longitudinal studies are needed using populations from more diverse countries or regions and from different cultures.

Keywords: Frailty, Social participation, Older people, Kihon checklist, Cross-sectional study, Logistic models, Mie prefecture, Smartphone, Sport, Local improvement

1. Introduction

With populations worldwide aging rapidly, frailty is gaining global attention. Frailty is a syndrome characterized by diminished strength, endurance, and reduced physiologic function, but it is not static; improvement is possible (Morley et al., 2013). Because frailty encompasses physical, mental, and social facets (Gobbens et al., 2010), it needs to be investigated and understood from all three perspectives.

In a systematic review of 21 high-income countries, the frailty prevalence was 4.0–59.1 % (Collard, Boter, Schoevers & Oude Voshaar, 2012), and in Japan, the prevalence was 4.6–9.5 % among community-dwelling older people (Kojima et al., 2017). Frailty can cause detrimental health outcomes such as falls, mobility impairment, decline in the ability to complete activities of daily living, hospitalization, death (Morley et al., 2013), cognitive impairment (Chu et al., 2021), and depression (Chu et al., 2020). Notably, the COVID-19 pandemic countermeasures drastically altered lifestyles around the world, and the post-pandemic frailty prevalence exceeds that of the period before COVID-19 (Hirose et al., 2023, Son et al., 2022). Therefore, it is imperative to improve strategies for preventing frailty in older adults.

A substantial body of research has established many factors as being associated with frailty, including age, sex, education, and economic status (Myers, Drory, Goldbourt & Gerber, 2014); diseases such as depression (Imaoka et al., 2021, Oyon et al., 2022), diabetes (Espinoza, Jung & Hazuda, 2012), heart failure and cerebrovascular diseases (Huang et al., 2022); living alone (Kojima, Taniguchi, Kitamura & Fujiwara, 2020); and social participation (Ning et al., 2023, Yamada et al., 2023, Abe et al., 2020). Of these factors, social participation is one of the most modifiable. Levasseur et al. defined social participation as a “person’s involvement in activities that provide interaction with others in society or the community,” which includes important shared spaces such as home and the Internet (Levasseur et al., 2010, Levasseur et al., 2022).

However, it has also been established that the effects of social participation on older people’s health vary according to type (Tomioka et al., 2018, Komatsu et al., 2019, Xie and Ma, 2021, Croezen et al., 2015) and frequency (Xie and Ma, 2021, Wang et al., 2021). For instance, researchers have found significant positive associations between physical health and engaging in hobbies (Tomioka et al., 2018, Komatsu et al., 2019), sports (Komatsu et al., 2019, Xie and Ma, 2021) and volunteering (Tomioka et al., 2018, Xie and Ma, 2021) and between both physical and mental health and engaging in sports (Ukawa et al., 2020, Ling et al., 2020) and learning activities (Croezen et al., 2015, Ling et al., 2020). As the findings indicate, there are established correlations between social participation among older adults and their physical health including frailty. However, it has also been established that frailty has physical, mental, and social components (Gobbens et al., 2010) and older people’s quality of life was affected by all physical, mental, and social well-being (Gothe et al., 2020). The World Health Organization has defined health as a state of complete physical, mental, and social well-being (World Health Organization, 2022) and has indicated that all three health-related perspectives must be apprehended for health promotion (World Health Organization, 1946). To the best of our knowledge, we are the first to comprehensively address the associations of social participation with all three facets together. This study aimed to determine the types and frequencies of social participation that were associated with the lowest level of comprehensive frailty among community-dwelling older people.

2. Material and methods

2.1. Study design, setting, and participants

This was a cross-sectional study involving community-dwelling older people. Our inclusion criteria were, first, the age should be ≥65 years. Second, individuals requiring less than care level one under Japan’s long-term care insurance system (care level one defined as the total estimated assisting care time per day is ≥32 min, but <50 min (Digital Agency of Japan, n.d.). In other words, such individuals find it difficult to perform the essential routine activities by themselves (Shinjuku City Long-term Care Insurance Division, 2018). Thus, they require partial care because their abilities to handle the routine instrumental activities are diminished to some extent (Shinjuku City Long-term Care Insurance Division, 2018). Third, they must have the ability to complete a self-administered questionnaire. The study areas were four cities and towns (Inabe City, Nabari City, Odai Town, and Kiho Town) in Mie Prefecture.

Mie Prefecture is long and thin and situated close to the center of Japan, and it covers an area of 5777 km2 (Mie Prefectural Government, 2023a). It has plains, basin areas, and mountainous regions that support agriculture, forestry, and fishing (Mie Prefectural Government, 2023a). In 2021, the population was approximately 1.8 million, and the aging rate was 29.9 % (Mie Prefectural Government, 2021). The study areas include all similar rural cities and towns. The population density of Nabari City, Inabe City, Kiho Town, and Odai Town were 588.6, 204.6, 129.6, and 23.9 inhabitants per km2, respectively, in 2021 (Mie Prefectural Government, 2023b). According to the Organisation for Economic Cooperation and Development, the urban area is defined as one with ≥1500 inhabitants per km2 (Organisation for Economic Cooperation and Development, 2013); therefore, the four cities and towns were classified as non-urban cities and towns.

2.2. Data collection

We administered the self-report questionnaire from June to November in 2022 with the cooperation of public health nurses and staff in the local governments of the four cities and towns. We distributed the questionnaires to individuals participating in group activities throughout communities or during home visits. When a visit could not be held because of COVID-19 pandemic restrictions, questionnaires were left at individuals’ homes, they filled them out, and they called us to let us know they had completed them.

2.3. Measurements

2.3.1. Frailty

The objective variable was comprehensive frailty status, that is, physical, mental and social frailty status. To measure frailty, we administered the Kihon Checklist (KCL) developed by the Ministry of Health, Labour and Welfare of Japan and widely used in Japan (Ministry of Health, Labour and Welfare of Japan, 2005). It consists of 25 questions regarding seven domains: instrumental activities of daily living, social activities of daily living, physical functions, nutrition status, oral function, cognitive function, and depression. The total KCL score significantly correlates with the total score for the Cardiovascular Health Study (CHS) criteria, which are the most-used frailty criteria globally (Satake et al., 2016). There is no international consensus on the cut-off score of the KCL for the prefrail and frail categories. The suggested cut-off scores were 3/4 (Satake et al., 2016, Esenkaya et al., 2019, Sentandreu-Mañó et al., 2021) and 4/5 (Wang et al., 2023) for prefrail and 5/6 (Sentandreu-Mañó et al., 2021), 6/7 (Watanabe et al., 2022, Salaffi et al., 2023), 7/8 (Satake et al., 2016), 8/9 (Esenkaya et al., 2019), and 10/11 (Wang et al., 2023) for frail. In this study, we adopted the cut-off score suggested by a previous study conducted in Japan and used the CHS criteria, namely, 3/4 for prefrail and 7/8 for frail (Satake et al., 2016).

2.3.2. Social participation

The explanatory variables were each of the following 23 types of social participation and the respondents’ frequency of participation in each: (i) interaction with friends, (ii) interaction with family living together, (iii) interaction with family living separately, (iv) taking care of family living together, (v) taking care of family living separately, (vi) interaction using smartphones, (vii) self-education (e.g., learning languages, computing, business), (viii) sports (e.g., walking, light physical exercise, jogging, fishing), (ix) local events, (x) hobbies and amusements (e.g., karaoke, dancing, gardening), and (xi) work.

We also tested the associations of participation in 12 kinds of volunteer activities: (xii) activities for older people (e.g., assisting in daily life or recreation activities), (xiii) activities related to disability (e.g., learning sign language or Braille), (xiv) activities related to children (e.g., supporting children’s group, helping with school events), (xv) health-related or medical activities (e.g., donating blood, visiting hospital patients), (xvi) local improvement activities (e.g., cleaning up parks and roads, planting flowers, promoting the local community), (xvii) safety promotion activities (e.g., disaster and crime prevention, road safety), (xviii) conservation or environmental activities (e.g., bird watching, promoting recycling or environmental preservation), (xix) disaster-related activities (e.g., donating to disaster victims), (xx) activities related to sports (e.g., coaching), (xxi) activities related to culture/art (e.g., volunteering at a museum), (xxii) activities related to science (e.g., participating in research studies), (xxiii) activities related to international cooperation (e.g., facilitating conferences, symposia, etc.).

We developed our study questionnaire based on the Survey on Time Use and Leisure Activities conducted by the Statistics Bureau of Japan (Statistics Bureau of Japan, 2021). Participation in each activity was answered with yes or no, and we divided frequency into eight categories: ≥4 times per week, 2–3 times per week, once per week, 2–3 times per month, once per month, several times per year, once per year, or none.

2.3.3. Confounding factors

The confounding factors we included were participants’ sociodemographic characteristics that had shown evidence of association with both frailty status and social participation (Myers et al., 2014, Espinoza et al., 2012, Huang et al., 2022, Kojima et al., 2020, Nemoto et al., 2018, Cook et al., 2022, Cohen-Mansfield et al., 2012, Chen et al., 2022). These included age group (65–74 years; ≥75 years), gender (female; male), cohabitants (yes; no), final academic background (elementary school, junior high school; high school; vocational school, junior college; university, college or more), economic situation (very good; good; poor; very poor), and existence of diseases under treatment or that are presenting after effects (yes; no).

2.4. Statistical analysis

We excluded respondents from our analysis who were missing responses on the KCL because we could not determine their frailty status. First, we calculated descriptive statistics for all variables. Second, we performed Fisher’s exact test to assess the relationships between each variable and frailty status. Third, ordinal logistic regression models were specified to examine the association between frailty status (frail, prefrail, and robust) and each type of social participation. We calculated unadjusted odds ratio (OR), adjusted odds ratio (AOR), and 95 % confidence interval (CI). Fourth, using the types of social participation that showed a statistically significant association with frailty status, we performed additional ordinal logistic regression analyses to assess the association between frailty status and the frequency (eight levels) of each type of social participation; in the case of complete separation, we combined some levels of frequency. We calculated OR and AOR (adjusted for confounding factors and other types of social participation) as well as 95 % CI, and we excluded variables with complete separation or potential multicollinearity (adjusted generalized variance inflation factor ≥2) from the models. We considered the results statistically significant if the 95 % CI did not overlap 1 or P < 0.05. All analyses were carried out using R version 4.2.2 (R Core Team, 2022).

2.5. Ethical approval and consent to participate

Written informed consent was obtained from all participants in this study. The study procedure was performed in accordance with the 1964 Helsinki Declaration and its later amendments. Ethical clearance for this study was received from the Clinical Research Ethics Review Committee of Mie University Hospital in 2022 (No. U2022-008).

3. Results

3.1. Participant characteristics

In the data cleaning process, 12 observations with missing or inconsistent responses were excluded from analysis: one missing response on the KCL and 11 inconsistent responses on the existence of cohabitants. Of the remaining 296 respondents, 74.0 % were female and 44.3 % were aged 65–74 years (Table 1). The prevalence of frail, prefrail, and robust were 21.3 %, 40.2 %, and 38.5 %, respectively. The types of social participation with the highest participation rate were interaction with friends (95.3 %) and with family living separately (86.4 %), although rates were also high for interactions using smartphones (84.1 %) and interactions with family living together (73.0 %).

Table 1.

Distribution of characteristics and social participation according among community-dwelling older people and to frailty status: Four cities and towns in Mie Prefecture of Japan, 2022.

Total
 Frail
 Prefrail
 Robust
 Pa
n (%) n (%) n (%) n (%)
Characteristics
Age (n = 296)
 65–74 years 131 (44.3) 17 (13.0) 48 (36.6) 66 (50.4) <0.001
 ≥75 years 165 (55.7) 46 (27.9) 71 (43.0) 48 (29.1)



Sex (n = 296)
 Female 219 (74.0) 49 (22.4) 89 (40.6) 81 (37.0) <0.001
 Male 77 (26.0) 14 (18.2) 30 (39.0) 33 (42.9)



Cohabitants (n = 296)
 Yes 224 (75.7) 45 (20.1) 91 (40.6) 88 (39.3) 0.661
 No 72 (24.3) 18 (25.0) 28 (38.9) 26 (36.1)



Economic situation (n = 295)
 Very good 18 (6.1) 2 (11.1) 6 (33.3) 10 (55.6) 0.032
 Good 203 (68.8) 37 (18.2) 82 (40.4) 84 (41.4)
 Poor 68 (23.1) 21 (30.9) 30 (44.1) 17 (25.0)
 Very poor 6 (2.0) 3 (50.0) 1 (16.7) 2 (33.3)



Education (n = 293)
 Elementary/Junior high school 80 (27.3) 28 (35.0) 29 (36.3) 23 (28.8) 0.008
 High school 152 (51.9) 29 (19.1) 60 (39.5) 63 (41.4)
 Vocational school/Junior college 41 (14.0) 6 (14.6) 19 (46.3) 16 (39.0)
 University/College or more 20 (6.8) 0 (0.0) 10 (50.0) 10 (50.0)



Disease (n = 294)
 Yes 185 (62.9) 45 (24.3) 78 (42.2) 62 (33.5) 0.039
 No 109 (37.1) 17 (15.6) 40 (36.7) 52 (47.7)



Types of social participation
Interaction with friends (n = 296)
 Yes 282 (95.3) 57 (20.2) 114 (40.4) 111 (39.4) 0.137
 No 14 (4.7) 6 (42.9) 5 (35.7) 3 (21.4)



Interaction with family living together (n = 296)
 Yes 216 (73.0) 42 (19.4) 88 (40.7) 86 (39.8) 0.647
 No 8 (2.7) 3 (37.5) 3 (37.5) 2 (25.0)
 Not applicable (No cohabitants) 72 (24.3) 18 (25.0) 28 (38.9) 26 (36.1)



Interaction with family living separately (n = 295)
 Yes 255 (86.4) 53 (20.8) 102 (40.0) 100 (39.2) 0.335
 No 14 (4.7) 6 (42.9) 4 (28.6) 4 (28.6)
 Not applicable (No cohabitants) 26 (8.8) 4 (15.4) 13 (50.0) 9 (34.6)



Taking care of family living together (n = 295)
 Yes 64 (21.7) 18 (28.1) 18 (28.1) 28 (43.8) 0.102
 No 159 (53.9) 27 (17.0) 73 (45.9) 59 (37.1)
 Not applicable (No cohabitants) 72 (24.4) 18 (25.0) 28 (38.9) 26 (36.1)



Taking care of family living separately (n = 296)
 Yes 27 (9.1) 4 (14.8) 12 (44.4) 11 (40.7) 0.750
 No 242 (81.8) 55 (22.7) 94 (38.8) 93 (38.4)
 Not applicable (No cohabitants) 27 (9.2) 4 (14.8) 14 (51.9) 9 (33.3)



Interaction using smartphones (n = 295)
 Yes 248 (84.1) 44 (17.7) 100 (40.3) 104 (41.9) <0.001
 No 47 (15.9) 19 (40.4) 19 (40.4) 9 (19.1)



Self-education (n = 295)
 Yes 67 (22.7) 13 (19.4) 27 (40.3) 27 (40.3) 0.904
 No 228 (77.3) 50 (21.9) 92 (40.4) 86 (37.7)



Sports (n = 295)
 Yes 195 (66.1) 34 (17.4) 81 (41.5) 80 (41.0) 0.068
 No 100 (33.9) 29 (29.0) 38 (38.0) 33 (33.0)



Local events (n = 293)
 Yes 48 (16.4) 8 (16.7) 19 (39.6) 21 (43.8) 0.634
 No 245 (83.6) 53 (21.6) 100 (40.8) 92 (37.6)



Hobbies and amusements (n = 293)
 Yes 198 (67.6) 38 (19.2) 82 (41.4) 78 (39.4) 0.613
 No 95 (32.4) 23 (24.2) 37 (38.9) 35 (36.8)



Work (n = 292)
 Yes 48 (16.4) 3 (6.3) 19 (39.6) 26 (54.2) 0.005
 No 244 (83.6) 58 (23.8) 100 (41.0) 86 (35.2)



Volunteer
Activities for older people (n = 290)
 Yes 89 (30.7) 12 (13.5) 36 (40.4) 41 (46.1) 0.055
 No 201 (69.3) 49 (24.4) 83 (41.3) 69 (34.3)



Activities for people with disability (n = 290)
 Yes 13 (4.5) 3 (23.1) 4 (30.8) 6 (46.2) 0.760
 No 277 (95.5) 58 (20.9) 114 (41.2) 105 (37.9)



Activities for children (n = 290)
 Yes 41 (14.1) 2 (4.9) 13 (31.7) 26 (63.4) <0.001
 No 249 (85.9) 59 (23.7) 105 (42.2) 85 (34.1)



Health or medical -related activities (n = 292)
 Yes 15 (5.1) 4 (26.7) 1 (6.7) 10 (66.7) 0.008
 No 277 (94.9) 57 (20.6) 118 (42.6) 102 (36.8)



Local improvement activities (n = 292)
 Yes 80 (27.4) 5 (6.3) 30 (37.5) 45 (56.3) <0.001
 No 212 (72.6) 56 (26.4) 89 (42.0) 67 (31.6)



Safety promotion activities (n = 292)
 Yes 32 (11.0) 4 (12.5) 12 (37.5) 16 (50.0) 0.302
 No 260 (89.0) 57 (21.9) 107 (41.2) 96 (36.9)



Conservation or environmental activities (n = 292)
 Yes 57 (19.5) 7 (12.3) 20 (35.1) 30 (52.6) 0.037
 No 235 (80.5) 54 (23.0) 99 (42.1) 82 (34.9)



Disaster-related activities (n = 291)
 Yes 20 (6.9) 1 (5.0) 6 (30.0) 13 (65.0) 0.033
 No 271 (93.1) 60 (22.1) 113 (41.7) 98 (36.2)



Activities related to sports (n = 290)
 Yes 9 (3.1) 0 (0.0) 3 (33.3) 6 (66.7) 0.144
 No 281 (96.9) 61 (21.7) 116 (41.3) 104 (37.0)



Activities related to culture/art (n = 291)
 Yes 13 (4.5) 2 (15.4) 4 (30.8) 7 (53.8) 0.579
 No 278 (95.5) 59 (21.2) 115 (41.4) 104 (37.4)



Activities related to science (n = 290)
 Yes 6 (2.1) 0 (0.0) 1 (16.7) 5 (83.3) 0.123
 No 284 (97.9) 61 (21.5) 118 (41.5) 105 (37.0)



Activities related to international cooperation (n = 292)
 Yes 2 (0.7) 0 (0.0) 0 (0.0) 2 (100.0) 0.191
 No 290 (99.3) 60 (20.7) 119 (41.0) 111 (38.3)
Open in a new tab
a

Fisher’s exact test. Boldface indicates statistical significance.

3.2. Types of social participation associated with frailty

We excluded three variables from the logistic regression analysis due to multicollinearity or complete separation: activities related to international cooperation, interaction with family living together, and cohabitants. The ordinal logistic regression model (Table 2) revealed associations between social participation types and the level of frailty. Lower level was associated with engaging in interaction using smartphones (AOR: 0.39, 95 % CI: 0.21–0.72), sports (AOR: 0.49, 95 % CI: 0.31–0.79), activities for children (AOR: 0.38, 95 % CI: 0.18–0.80), and local improvement activities (AOR: 0.43, 95 % CI: 0.25–0.75). In contrast, older people who engaged in self-education were more likely to be frail (AOR: 1.77, 95 % CI: 1.03–3.04).

Table 2.

The odds ratios of social participation types for the level of frailty among community-dwelling older people: Four cities and towns in Mie Prefecture of Japan, 2022.

OR 95 % CI AOR a 95 % CI
Types of social participation
Interaction with friends
 Yes 0.36 0.17 0.79 0.62 0.24 1.62
 No 1.00 reference 1.00 reference



Interaction with family living separately
 Yes 0.43 0.20 0.94 0.90 0.34 2.37
 No 1.00 reference 1.00 reference



Taking care of family living together
 Yes 1.06 0.70 1.60 0.97 0.56 1.69
 No 1.00 reference 1.00 reference



Taking care of family living separately
 Yes 0.81 0.45 1.44 1.13 0.54 2.40
 No 1.00 reference 1.00 reference



Interaction using smartphones
 Yes 0.32 0.20 0.51 0.39 0.21 0.72
 No 1.00 reference 1.00 reference



Self-education
 Yes 0.88 0.60 1.31 1.77 1.03 3.04
 No 1.00 reference 1.00 reference



Sports
 Yes 0.62 0.44 0.88 0.49 0.31 0.79
 No 1.00 reference 1.00 reference



Local events
 Yes 0.76 0.48 1.19 1.19 0.66 2.14
 No 1.00 reference 1.00 reference



Hobbies and amusements
 Yes 0.84 0.59 1.19 1.01 0.63 1.61
 No 1.00 reference 1.00 reference



Work
 Yes 0.41 0.25 0.66 0.73 0.40 1.33
 No 1.00 reference 1.00 reference



Volunteer
Activities for older people
 Yes 0.57 0.40 0.83 1.14 0.67 1.93
 No 1.00 reference 1.00 reference



Activities for people with disability
 Yes 0.83 0.37 1.86 0.73 0.24 2.21
 No 1.00 reference 1.00 reference



Activities for children
 Yes 0.28 0.16 0.48 0.38 0.18 0.80
 No 1.00 reference 1.00 reference



Health or medical related activities
 Yes 0.41 0.18 0.94 1.31 0.42 4.11
 No 1.00 reference 1.00 reference



Local improvement activities
 Yes 0.32 0.21 0.48 0.43 0.25 0.75
 No 1.00 reference 1.00 reference



Safety promotion activities
 Yes 0.57 0.33 0.99 1.01 0.46 2.24
 No 1.00 reference 1.00 reference



Conservation or environmental activities
 Yes 0.48 0.31 0.74 1.10 0.59 2.06
 No 1.00 reference 1.00 reference



Disaster related activities
 Yes 0.29 0.14 0.62 0.43 0.15 1.23
 No 1.00 reference 1.00 reference



Activities related to sports
 Yes 0.26 0.08 0.83 0.98 0.20 4.79
 No 1.00 reference 1.00 reference



Activities related to culture/art
 Yes 0.54 0.23 1.27 1.50 0.47 4.79
 No 1.00 reference 1.00 reference



Activities related to science
 Yes 0.11 0.02 0.70 0.17 0.02 1.61
 No 1.00 reference 1.00 reference
Open in a new tab

Abbreviation: OR, odds ratio; AOR, adjusted odds ratio, CI, confidence interval.

Ordinal logistic regression analysis. Objective variable: frailty status (frail, prefrail, and robust). Higher OR means greater level of frailty. Boldface indicates statistical significance.

OR and AOR were calculated by excluding “not applicable” cases.

a

Adjusted for confounding factors (i.e., age group, gender, education, economic situation and diseases).

3.3. Frequency of social participation associated with frailty

Using the five types of social participation that showed a significant association with frailty status, we performed additional ordinal logistic regression analyses for each to assess the association between its frequency and frailty. One third of participants (39.2 %) interacted using smartphones ≥4 times per week, followed by 2–3 times per week (19.8 %) (Table 3). The frailty level was lowest with 2–3 times per month (AOR: 0.21, 95 % CI: 0.07–0.58), followed by once per week (AOR: 0.33, 95 % CI: 0.15–0.75), ≥4 times per week (AOR: 0.36, 95 % CI: 0.18–0.73) (Table 4). There was no significant association between frailty and the frequency of self-education.

Table 3.

Frequency of social participation among community-dwelling older people and according to frailty status: Four cities and towns in Mie Prefecture of Japan, 2022.

Total
 Frail
 Prefrail
 Robust
 Pa
n (%) n (%) n (%) n (%)
Interaction using smartphones (n = 293)
 ≥4 times per week 115 (39.2) 18 (15.7) 47 (40.9) 50 (43.5) 0.035
 2–3 times per week 58 (19.8) 12 (20.7) 25 (43.1) 21 (36.2)
 Once per week 42 (14.3) 7 (16.7) 17 (40.5) 18 (42.9)
 2–3 times per month 20 (6.8) 3 (15.0) 6 (30.0) 11 (55.0)
 Once per month 11 (3.8) 4 (36.4) 4 (36.4) 3 (27.3)
 None 47 (16.0) 19 (40.4) 19 (40.4) 9 (19.1)



Self-education (n = 295)
 ≥4 times per week 6 (2.0) 1 (16.7) 3 (50.0) 2 (33.3) 0.910
 2–3 times per week 10 (3.4) 1 (10.0) 3 (30.0) 6 (60.0)
 Once per week 31 (10.5) 9 (29.0) 12 (38.7) 10 (32.3)
 2–3 times per month 11 (3.7) 1 (9.1) 4 (36.4) 6 (54.5)
 Once per month 4 (1.4) 1 (25.0) 2 (50.0) 1 (25.0)
 Several times per year 5 (1.7) 0 (0.0) 3 (60.0) 2 (40.0)
 None 228 (77.3) 50 (21.9) 92 (40.4) 86 (37.7)



Sports (n = 295)
 ≥4 times per week 45 (15.3) 5 (11.1) 20 (44.4) 20 (44.4) 0.131
 2–3 times per week 48 (16.3) 8 (16.7) 20 (41.7) 20 (41.7)
 Once per week 62 (21.0) 10 (16.1) 28 (45.2) 24 (38.7)
 2–3 times per month 29 (9.8) 9 (31.0) 6 (20.7) 14 (48.3)
 Once per month 7 (2.4) 1 (14.3) 5 (71.4) 1 (14.3)
 Several times per year 4 (1.4) 1 (25.0) 2 (50.0) 1 (25.0)
 None 100 (33.9) 29 (29.0) 38 (38.0) 33 (33.0)



Local improvement activities (n = 291)
 ≥4 times per week 4 (1.4) 1 (25.0) 1 (25.0) 2 (50.0) 0.042
 2–3 times per week 6 (2.1) 0 (0.0) 2 (33.3) 4 (66.7)
 Once per week 5 (1.7) 0 (0.0) 2 (40.0) 3 (60.0)
 2–3 times per month 8 (2.7) 1 (12.5) 2 (25.0) 5 (62.5)
 Once per month 17 (5.8) 1 (5.9) 8 (47.1) 8 (47.1)
 Several times per year 28 (9.6) 2 (7.1) 10 (35.7) 16 (57.1)
 Once per year 12 (4.1) 0 (0.0) 5 (41.7) 7 (58.3)
 None 211 (72.5) 55 (26.1) 89 (42.2) 67 (31.8)



Activities for children (n = 290)
 ≥4 times per week 4 (1.4) 0 (0.0) 1 (25.0) 3 (75.0) 0.016
 2–3 times per week 2 (0.7) 1 (50.0) 1 (50.0) 0 (0.0)
 2–4 times per month 8 (2.8) 0 (0.0) 2 (25.0) 6 (75.0)
 Once per month 8 (2.8) 0 (0.0) 4 (50.0) 4 (50.0)
 Several times per year 14 (4.8) 0 (0.0) 3 (21.4) 11 (78.6)
 Once per year 5 (1.7) 1 (20.0) 2 (40.0) 2 (40.0)
 None 249 (85.9) 59 (23.7) 105 (42.2) 85 (34.1)
Open in a new tab
a

Fisher’s exact test. Boldface indicates statistical significance.

Table 4.

The odds ratios of frequency of social participation for the level of frailty among community-dwelling older people: Four cities and towns in Mie Prefecture of Japan, 2022.

OR 95 % CI AOR a 95 % CI
Model 1: Interaction using smartphones
 ≥4 times per week 0.29 0.18 0.49 0.36 0.18 0.73
 2–3 times per week 0.40 0.23 0.70 0.48 0.23 1.02
 Once per week 0.30 0.16 0.57 0.33 0.15 0.75
 2–3 times per month 0.20 0.09 0.45 0.21 0.07 0.58
 Once per month 0.74 0.29 1.93 0.46 0.14 1.48
 None 1.00 reference 1.00 reference



Model 2: Self-education
 ≥4 times per week 1.00 0.31 3.22 3.14 0.67 14.65
 2–3 times per week 0.40 0.15 1.09 1.21 0.30 4.91
 Once per week 1.36 0.80 2.33 1.78 0.84 3.79
 2–3 times per month 0.47 0.19 1.21 1.16 0.30 3.95
 Once per month 1.47 0.36 6.04 2.15 0.39 11.91
 Several times per year 0.63 0.17 2.35 3.54 0.59 21.38
 None 1.00 reference 1.00 reference



Model 3: Sports
 ≥4 times per week 0.50 0.30 0.84 0.36 0.18 0.71
 2–3 times per week 0.60 0.37 0.99 0.47 0.24 0.92
 Once per week 0.65 0.41 1.02 0.42 0.23 0.78
 2–3 times per month 0.68 0.37 2.23 0.72 0.33 1.57
 Once per month 1.11 0.37 3.30 2.79 0.68 11.41
 Several times per year 1.11 0.27 4.61 0.69 0.12 3.81
 None 1.00 reference 1.00 reference



Model 4: Local improvement activities
 ≥4 times per week 0.57 0.13 2.50 1.38 0.22 8.63
 2–3 times per week 0.20 0.05 0.84 0.55 0.09 3.19
 Once per week 0.26 0.06 1.14 0.52 0.03 8.64
 2–3 times per month 0.29 0.09 0.91 0.53 0.13 2.08
 Once per month 0.43 0.20 0.92 0.59 0.23 1.51
 Several times per year 0.32 0.17 0.60 0.27 0.12 0.63
 Once per year 0.27 0.11 0.71 0.44 0.14 1.39
 None 1.00 reference 1.00 reference



Model 5: Activities for children
 ≥4 times per week 0.16 0.02 1.07 0.27 0.02 2.99
 2–3 times per week 4.16 0.47 37.13 1.10 0.04 29.82
 2–4 times per month 0.16 0.04 0.62 0.20 0.04 0.95
 Once per month 0.41 0.13 1.23 0.58 0.12 2.73
 Several times per year 0.13 0.04 0.39 0.24 0.06 0.93
 Once per year 0.78 0.21 2.88 0.98 0.22 4.38
 None 1.00 reference 1.00 reference
Open in a new tab

Abbreviation: OR, odds ratio; AOR, adjusted odds ratio, CI, confidence interval.

Ordinal logistic regression analysis. Objective variable: frailty status (frail, prefrail, and robust). Higher OR means greater level of frailty. Boldface indicates statistical significance.

a

Each model was adjusted for confounding factors and participation of other 20 types of social participation.

One fifth of participants (21.0 %) engaged in sports once per week, followed by 2–3 times per week (16.3 %) and ≥4 times per week (15.3 %) (Table 3). The frailty level was lowest with ≥4 times per week (AOR: 0.36, 95 % CI: 0.18–0.71), followed by once per week (AOR: 0.42, 95 % CI: 0.23–0.78) and 2–3 times per week (AOR: 0.47, 95 % CI: 0.24–0.92) (Table 4). Most participants did not engage in local improvement activities (72.5 %) (Table 3); however, lower frailty level was associated with participating just several times per year (AOR: 0.27, 95 % CI: 0.12–0.63) (Table 4). Similarly, most participants did not engage in activities for children (85.9 %) (Table 3), but among those who did, doing so 2–4 times per month and several times per year were associated with a lower level of frailty (AOR: 0.20, 95 % CI: 0.04–0.95; AOR: 0.24, 95 % CI: 0.06–0.93, respectively) (Table 4).

4. Discussion

This study is the first examination of associations between comprehensive frailty and the types and frequency of social participation among older people in Japan. The prevalences of frail (21.3 %) and prefrail (40.2 %) were higher than those found by previous researchers who used the KCL (Hagiyama et al., 2022, Shimazaki et al., 2020), but this was because the participants in this study had a higher mean age (76.7 years) than that in previous studies. Furthermore, we conducted our study during the COVID-19 pandemic. Research has established that frailty rates are higher since the pandemic than they were before (Hirose et al., 2023) because people tended to refrain from going out and interacting with others during the COVID-19 pandemic to prevent infection resulting in decline in physical activity and social participation.

We also found higher social participation rates for many activities than did authors of studies targeting general older populations (Cabinet Office of Japan, 2021a, Statistics Bureau of Japan, 2022). This was because we did not include any adults who were certified as needing long-term care. In addition, the employment rate among our participants was lower than that found in the national survey (16.4 % vs. 37.0 %) (Cabinet Office of Japan, 2021a). People who do not work may have time and relaxed mind to participate in social activities.

The key finding of this study was that a lower level of comprehensive frailty was associated with using smartphones, with the lowest odds for using a phone 2–3 times per month. In findings from earlier longitudinal studies, contact with people by phone or online was associated with reduced level of cognitive decline (Amini, Chee, Mendieta & Parker, 2019). During the COVID-19 lockdowns, 66.3 % of people in their 60s and even 49.0 % of people 70 or older reported that digital devices such as smartphone had become indispensable for the new way they had to live (Cabinet Office of Japan, 2021b). Ministry of Health, Labour, and Welfare of Japan endorses health promotion activities and supports venues labeled “Kayoi-no-ba” where older people can casually meet in their communities, and can plan and conduct activities (e.g., exercise, cooking, farming) by interacting with others (Ministry of Health, Labour and Welfare of Japan, n.d.). The National Center for Geriatrics and Gerontology has developed a smartphone application for the “Kayoi-no-ba.” Older people can interact with others using this application (National Center for Geriatrics and Gerontology, n.d.). Given this finding, one important way to help reduce frailty in older adults is to ensure that they have access to digital devices that allow them to maintain contact even when they are homebound.

Participating in local improvement activities several times per year was associated with a lower level of frailty in our study. Previous studies have shown that holding leadership positions leads to a lower risk of developing dementia (Nemoto et al., 2017) and a lower risk of depression (Takagi et al., 2018). It is noteworthy that highest frequency in this study was no-participation (72.5 %), followed by participating in several times a year (9.6 %). Previous study revealed that participation in volunteer activities for a long time was associated with lower self-rated health (Van Willigen, 2000) and higher mortality (Musick, Herzog & House, 1999). It is possible that frequent participation in such activities can be burdensome if not practiced in moderation. Thus, it is paramount for older people to participate in the activity with appropriate frequency.

Participating in activities for children 2–4 times per month and several times per year were also associated with a lower level of frailty, possibly because interacting with youngsters gives older adults a sense of fulfillment and purpose in passing on their knowledge and experience to the younger generation. This aligns with longitudinal study findings in which interacting with children in primary school and kindergarten improved older adults’ depressive symptoms (Kamei et al., 2011), and self-rated health (Fujiwara et al., 2009). However, most of our respondents (85.9 %) did not engage in activities with children, and it could be important to increase older adults’ opportunities for such engagement. A child-rearing volunteer organization in Japan, named “Family Support Center,” offers services such as taking care of children before and after the working hours of daycare facilities, transferring them to their daycare facilities, and taking charge of children after their club meetings or after-school activities (Cabinet Office of Japan, 2012). Many volunteers at this organization are aged ≥60 years (Cabinet Office of Japan, 2012). Results of our study indicate that frailty could be prevented if older people are prompted to engage in such activities.

Lower level of comprehensive frailty was also associated with participation in sports activities, with the lowest level for participation ≥4 times per week. This result was consistent with findings from previous studies that physical exercise decreased the risk of physical frailty (Xie and Ma, 2021, Wang et al., 2021). Sports creates opportunities for diverse community members to connect with each other, and social connections have also been associated with a reduced risk of depression (Domènech-Abella, Mundó, Haro & Rubio-Valera, 2019), as well as less cognitive decline (Saito et al., 2021), and physical decline (Imamura et al., 2020). It was a new finding that participation in sports was associated with a lower level of comprehensive frailty.

This study has six limitations. First, the study followed a cross-sectional design, which does not allow causal relationships to be determined. Second, we conducted this survey in four cities in one prefecture, which might make our results less generalizable given previous findings of regional differences in frailty prevalence (Sinclair et al., 2022); future researchers could conduct similar studies across broader areas. Third, volunteer bias is a concern because random sampling was not applied. Besides, social-desirability bias could result from the self-administered questionnaire of this study. Fourth, the results can differ if the cut-off value of the KCL for the pre-frail and frailty categories was adopted. Fifth, the experience of surviving the COVID-19 pandemic might have changed older people’s attitudes and behavior related to social contact, and future longitudinal researches could assess such changes between before and after the pandemic. Sixth, frailty and social participation levels could differ for respondents depending on data collection methods (i.e., through group activities or home visits).

5. Conclusions

In conclusion, among older people in Japan, a lower level of comprehensive frailty was associated with the frequency of engaging in certain types of social activities, specifically, smartphone interaction 2–3 times per month, sports ≥4 times per week, local improvement activities several times per year, and activities for children 2–4 times per month. Promoting social participation with appropriate frequency might effectively prevent comprehensive frailty for older people.

CRediT authorship contribution statement

Nanako Saeki: Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Writing – original draft. Mayumi Mizutani: Conceptualization, Methodology, Investigation, Writing – original draft, Project administration. Susumu Tanimura: Conceptualization, Methodology, Formal analysis, Writing – review & editing. Ritsuko Nishide: Conceptualization, Methodology, Investigation, Writing – review & editing, Project administration.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We are grateful to the participants for their participation in this study. We also thank the staff of the health department in Inabe City, Nabari City, Odai Town, and Kiho Town for their cooperation. This work is part of a master’s thesis submitted to Mie University Graduate School of Medicine, Japan.

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