Roles in Kayoino-ba and their relationship with Ikigai, functional ability, and frailty in older adults

Abstract

[Purpose] Independent group activities (Kayoino-ba) are expected to improve Ikigai (a sense of purpose) among older adults in the community. The differences in Ikigai, physical and mental function, and frailty among older adults, participating in Kayoino-ba, were examined by comparing participants with and without group roles. [Participants and Methods] Older adults who engaged in Kayoino-ba were enrolled. Physical function was assessed using grip strength, the five-times sit-to-stand test, the 5-meter walking time, and the Timed Up and Go test. Participants were grouped by role status, and intergroup comparisons were performed. Ikigai was the dependent variable and role status was the independent variable, with age group, sex, participation, and frailty as covariates. Clustering was adjusted using generalized estimating equations. [Results] In total, 265 participants (20 groups) participated in this study. Participants with a group role had significantly lower frailty and superior performance in grip strength, the Timed Up and Go test, Ikigai-9, Kihon Checklist, and Life Space Assessment than participants who did not have a group role. Multivariable generalized estimating equation analysis showed that participants who had a group role had a significantly greater likelihood of reporting Ikigai (odds ratio=7.14, 95% confidence interval: 1.12–45.52). [Conclusion] Having a group role may be an important factor associated with Ikigai among older adults, and it could positively contribute to healthy aging.

INTRODUCTION

Japan has one of the world’s most rapidly aging populations. Consequently, strategies to address this demographic trend include health promotion and the prevention of long-term care. In 2013, the “Comprehensive Program for Care Prevention and Daily Life Support” (Sogo Jigyo) was established as a new insurance system for long-term care prevention. Japan prioritizes a population-based approach as a key strategy for care prevention¹⁾ and promotes the nationwide development of “activities using the passage of older adults” (Kayoino-ba)^1,2,3). At the first Joint Meeting on Long-term Care Prevention Staff and Advisors, it was stated that the goal of long-term care prevention is “to provide a place where older adults can dwell with Ikigai and a role in the community, potentially leading to the prevention of long-term care for older adults”³⁾. Accordingly, Kayoino-ba is expected to serve as a setting where older adults can find Ikigai in life. Kayoino-ba broadly refers to resident-centered activities aimed at preventing long-term care needs through exercise, hobbies, and other group-based programs²⁾. A 2015 survey by the Ministry of Health, Labour and Welfare reported 70,134 Kayoino-ba locations nationwide, involving 1,317,773 participants (3.8% of the older adult population)⁴⁾. By 2023, the number had increased to 157,638 locations with 2,418,838 participants (6.7%)⁵⁾. Regarding the effects of long-term care prevention activities at Kayoino-ba, one study reported that older adults who regularly participated in hobbies and sports had lower subsequent care costs as well as reduced risk of requiring support or care^{6, 7)}. Participation in group activities has also been associated with maintaining physical ability, reducing the risk of dementia, and improving subjective health^8,9,10). Furthermore, holding roles in community groups has been linked to reduced mortality risk and better psychosocial health^11,12,13). We hypothesized that individuals with managerial roles in Kayoino-ba, such as leaders or organizers, would experience a stronger sense of Ikigai than those without a role. Ikigai is often translated as “purpose in life”, “reason for living”, or “psychological well-being”. However, it is a uniquely Japanese concept with multifaceted dimensions. Sone et al.¹⁴⁾ described Ikigai as that which gives life meaning and makes it worth living, whereas Kamiya¹⁵⁾ defined it as a state of mind, such as joie de vivre or “satisfaction in living”, that arises from one’s life and the activities or objects that evoke such feelings. Thus, having Ikigai may promote mental and physical health. Previous studies have associated Ikigai with reduced depressive symptoms, hopelessness, functional disability, and mortality, as well as greater happiness, life satisfaction, and physical health^{14, 16,17,18)}.

We further hypothesized that participants with roles in Kayoino-ba would demonstrate better physical and mental health, as well as a lower prevalence of frailty, than those without roles. Frailty is an intermediate state between robustness and the need for nursing care, encompassing physical, cognitive, and psychological problems such as cognitive decline and depression¹⁹⁾. Age-related frailty is linked to increased risk of adverse outcomes, including hospitalization, falls, institutionalization, and death²⁰⁾. Therefore, we hypothesized that role participation in group activities would be associated with higher Ikigai scores and inversely associated with frailty. However, no studies have yet examined the relationship between roles and Ikigai in older adults. Clarifying whether older adults experience Ikigai through participation and role engagement in Kayoino-ba is important.

We examined whether differences exist in the state of Ikigai, physical and mental function, and frailty according to group roles and identified factors associated with Ikigai among Kayoino-ba participants.

PARTICIPANTS AND METHODS

We included older adults from the Fukuroi City Senior Center who participated in Kayoino-ba and provided informed consent. The application period was between August 24 and September 15, 2024.

Measurements were conducted at each group’s usual activity venue, with data collected by university students and physical therapists who had received prior training in measurement methods. In total, 71 students and 21 physical therapists served as evaluators. Each venue included 3–7 students and 1–2 physical therapists. University students guided participants and conducted measurements, while physical therapists supervised the overall measurement process to ensure safety. Motor function assessments included grip strength, the five-times sit-to-stand test (SS-5) , 5-meter walking time at normal and maximum speeds, and the Timed Up and Go test (TUG). Grip strength was measured using a dynamometer (T.K.K.5401, Takei Kiki Kogyo, Niigata, Japan). Each participant performed two trials per hand, alternating sides, and the maximum value for each hand was recorded. Gait was measured indoors on a 5 m long, 2 m wide walking path. Floor materials varied by venue (e.g., flooring or tatami mats), and participants wore socks or shoes. Daily walking aids (e.g., canes) were allowed. Time from the start signal to crossing the finish line was recorded using a stopwatch. A self-administered questionnaire was used to collect data on sex, age, participation status, presence of roles in Kayoino-ba, the Ikigai-9 scale²¹⁾, the Kihon Checklist²²⁾, and the Life Space Assessment (LSA), an index used to assess the extent of spatial activity. Frailty was evaluated using the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria²³⁾, with participants classified as frail (≥3 of 5 items), pre-frail (1–2 items), or robust (0 items)²³⁾. To assess participants’ roles in group activities, they selected the role closest to theirs from the following options: (a) Role (1): leaders, organizers, and liaisons; (b) Role (2): treasurers, venue reservation, and preparation; and (c) Role (3): participation only. The Ikigai-9 scale, ranging from 9–45, was used to assess Ikigai, with higher scores indicating a stronger sense of Ikigai²¹⁾. As few participants were in Role (2), Roles (1) and (2) were combined into a “Role group”, and Role (3) was categorized as the “No Role group”, creating two comparison groups. Differences between groups were analyzed using the χ² or unpaired t-test. Ikigai was assessed using Ikigai-9. A receiver operating characteristic analysis, using depressive symptoms from the Kihon Checklist as an external criterion, was conducted to determine the cut-off point, which corresponded to the maximum Youden Index (24.5 points) was used to dichotomize Ikigai: ≥25 points=High Ikigai, ≤24 points=Low Ikigai. This score was used as the dependent variable, with the presence of roles as the independent variable, and age group, sex, years of participation, participation frequency, and frailty as covariates. Analyses were conducted using Generalized Estimating Equations (GEE), with clustering by 20 groups to account for intra-group correlation. We analyzed the model without covariates as the Crude Model and with covariates as the Adjusted Model. The GEE model employed a binomial distribution and a logistic (Logit) link function. Results were reported as regression coefficients (B), odds ratios (Exp(B)), and 95% confidence intervals (95% CI). As a sensitivity analysis, Ikigai-9 scores were dichotomized at the median and analyzed using the same method. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY, USA), with significance set at 5%.

The Research Ethics Review Committee of Shizuoka Sangyo University approved this study (approval number: S24006). All participants were informed of the study’s purpose and provided written consent before participation.

RESULTS

The basic characteristics of participants are listed in Table 1. This study sent invitations to 103 registered groups at the Fukuroi Senior Center, obtaining consent from 20 of them. Participants belonging to these 20 groups numbered 285. Among them, 11 individuals declined participation due to refusal to undergo measurements or physical conditions such as orthopedic disorders, resulting in 274 consenting participants. Excluding 9 participants who did not answer the role-related questions, the final sample size for analysis was 265 individuals (Fig. 1). Overall, 265 participants from 20 groups were included, comprising 52 males and 213 females.

Table 1. Participant characteristics (N=265).

		Total (N=265)		Role (N=80)		No Role (N=185)		OR	95% CI	p
		N	%	N	%	N	%
Sex								0.1	0.1–0.2	**
	Men	52	19.6	37	46.3	15	8.1
	Women	213	80.4	43	53.8	170	91.9
Age group								1.4	–0.8–2.5
	Young-old adult	77	29.2	27	34.2	50	27.0
	Old-old adult	187	70.8	52	65.8	135	73.0
Participation
	Duration (1–4)	4.0	3.0–4.0	4.0	4.0–4.0	4.0	3.0–4.0			**
	Frequency (1–3)	3.0	2.0–3.0	3.0	2.0–3.0	2.0	2.0–3.0			**
J-CHS										*
	Robust	111	42.9	39	49.4	72	40.0
	Pre-frailty	131	50.6	39	49.4	92	51.1
	Frailty	17	6.6	1	1.3	16	8.9

Role group: Participants involved as leaders, organizers, liaisons, treasurers, or in venue reservation/preparation.

No Role group: Participants engaged only in participation (no specific role).

**p<0.01, *p<0.05.

Young-old adults: 65–74 years; Old-old adults: ≥75 years.

The duration and frequency of participation are shown as the median and 95% confidence interval.

Duration (1; ≤1 year, 2; 1 ≤ 2 year, 3; 2 ≤5 year, 4; ≥5 year).

Frequency (1; ≤1/week, 2; 1/week, 3; ≥2/week).

Frailty categories: Robust (0 items), Pre-frail (1–2 items), Frailty (≥3 items).

CI: confidence interval; OR: odds ratio; J-CHS: Japanese version of the Cardiovascular Health Study.

Fig. 1.

Flowchart of participants.

Regarding age, 77 participants were classified as young-old adults and 187 as old-old adults. In terms of group roles, 80 participants (30.2%) held roles in Kayoino-ba, including 64 (24.2%) in Role (1) and 16 (6.0%) in Role (2), while 185 participants (69.8%) did not hold any role (Role (3)). According to the J-CHS criteria, 111 participants (42.9%) were robust, 131 (50.6%) were pre-frail, and 17 (6.6%) were frail. The No Role group (Role (3)) had a higher proportion of frail individuals than that of the Role group (Roles (1) and (2)).

Comparison between the two groups revealed significant differences in grip strength, TUG, Ikigai-9, Kihon Checklist, and LSA scores. The Role group performed significantly better than the No Role group across all these measures (Table 2).

Table 2. Comparison of functional and psychological measures by group role.

		Total (N=265)		Role (N=80)		No Role (N=185)		Mean difference	Cohen’s d	p
		Mean	SD	Mean	SD	Mean	SD	(95% CI)	95% CI
Grip strength	kg	24.1	6.9	29.1	8.0	21.9	4.9	–7.2(–9.1 to –5.3)	–1.2(–1.5 to –0.9)	**
SS-5	s	7.4	2.9	7.1	3.1	7.5	2.8	0.4(–0.4 to 1.2)	0.1(–0.1 to 0.4)
5WT (normal)	s	4.1	1.5	4.0	1.4	4.2	1.6	0.2(–0.2 to 0.6)	0.1(–0.1 to 0.4)
5WT (maximum)	s	3.3	1.4	3.2	1.3	3.4	1.4	0.3(–0.1 to 0.6)	0.2(–0.1 to 0.5)
TUG	s	6.9	2.2	6.3	1.4	7.1	2.4	0.9(0.3 to 1.4)	0.4(0.1 to 0.7)	**
Ikigai-9	(9–45)	30.9	6.2	33.9	5.5	29.6	6.0	–4.2(–5.8 to –2.7)	–0.7(–1.0 to –0.5)	**
Kihon Checklist	(1–25)	5.3	3.6	3.7	3.2	6.0	3.5	2.3(1.3 to 3.2)	0.6(0.4 to 0.9)	**
LSA	(0–120)	81.9	22.4	88.8	19.0	78.7	23.2	–10.1(–15.5 to –4.6)	–0.5(–0.7 to –0.2)	**

Role group: Participants involved as leaders, organizers, liaisons, treasurers, or in venue reservation/preparation.

No Role group: Participants engaged only in participation (no specific role).

**p<0.01, *p<0.05.

SS-5: five-times sit-to-stand test; 5WT: 5-meter walking time; TUG: timed up and go test; LSA: life space assessment; SD: standard deviation; CI: confidence interval.

In the multivariable GEE analysis, participants with roles had significantly higher odds of having Ikigai (odds ratio=7.140, 95% CI: 1.12–45.52, p<0.05; Table 3). The analysis adjusted for age group, sex, frailty, participation frequency, and years of participation, and accounted for clustering within 20 groups. Sensitivity analysis, conducted by binning Ikigai-9 scores at the median (31 points), yielded similar results. These findings indicate that the presence of roles is independently associated with Ikigai.

Table 3. Relationship between the level of meaning in life and role.

		Total	High Ikigai		Crude model			Adjusted model
		N	N	%	OR	95% CI	p	OR	95% CI	p
Role
	without	185	146	78.9	Ref.			Ref.
	with	80	78	97.5	10.65	2.35–48.38	<0.01	7.14	1.12–45.52	0.04

Crude model; no adjustment.

Adjusted model; examined using multiple logistic regression analysis with age group, sex, years of participation, participation frequency, and frailty as adjustment variables.

Specified 20 groups as cluster variables.

OR: odds ratio; CI: confidence interval.

DISCUSSION

We investigated whether Ikigai and physical and mental functions differed according to participants’ roles in group activities, aiming to clarify the relationship between group roles and Ikigai and identify factors associated with Ikigai among Kayoino-ba participants. The results showed that older adults responsible for group management, such as leaders and organizers, were less frail, participated in volunteer groups for longer durations, and demonstrated better physical activity, functional ability, Ikigai, and life space compared with those without specific roles. Furthermore, participants with roles reported higher Ikigai, indicating that the presence of roles is independently associated with Ikigai.

Ejiri et al.¹²⁾ reported that, in volunteer group activities for older adults, role-oriented participants such as leaders and supporters demonstrated higher psychosocial health than those without roles. Takagi et al.¹³⁾ found that role-based social participation reduced the risk of depression, particularly among men. Ishikawa et al.¹¹⁾ observed a 12% reduction in mortality risk among older adults with community roles compared to those without, based on a 5 year follow-up study. Nemoto et al.⁹⁾ investigated the relationship between community roles and onset of dementia, reporting a 19% lower risk of developing dementia among older adults with roles than those without.

Consistent with these findings, our study also showed that participants with roles in group activities exhibited better health status and higher Ikigai. Several factors may explain the higher Ikigai and better health observed in these individuals: (i) they may engage in more physical activity and maintain better function owing to more frequent opportunities to go out²⁴⁾. (ii) interpersonal communication and social interaction may support a positive mental state, enhancing self-esteem, social competence, and mood^{10, 13)}. (iii) They are more likely to attend Kayoino-ba, where they may be exposed to valuable health-related information²⁵⁾. Additionally, continued participation in structured activities, such as frailty prevention exercises, may help maintain a good mental state¹⁰⁾. Tsujishita et al.²⁶⁾ reported that overlapping physical, cognitive, and social frailty factors were negatively associated with Ikigai among community-dwelling older adults, consistent with our findings. A healthier lifestyle, physically and mentally, may indirectly strengthen one’s sense of Ikigai. Even participants without designated roles can be encouraged to take small, active steps, such as putting away chairs or initiating conversations with others, which may enhance their health and Ikigai. Promoting active participation also helps sustain group dynamics and effective management. Therefore, assuming social roles in enjoyable, group-based settings may help promote health and well-being among older adults, potentially contributing to long-term care prevention. However, because this was a cross-sectional study, we cannot determine causality; whether participants became healthier owing to their roles or if healthier individuals were more likely to take on roles remains unclear. Despite its strengths, this study has certain limitations. First, we examined only activities at Kayoino-ba and did not consider roles participants may have held in other social or community settings. Second, the classification of roles may differ depending on the type of activity and management style of each Kayoino-ba. Third, we did not account for geographic or environmental differences in participants’ living areas. Forth, due to variations in flooring materials and footwear at measurement venues, bias may exist between venues. Finally, the study population is limited to participants who obtained consent from a specific region, potentially skewing toward individuals with higher health awareness, thereby limiting generalizability. Nevertheless, to the best of our knowledge, this is the first study to examine the relationship between roles and Ikigai in the context of Kayoino-ba.

These findings provide important foundational data to guide the development of long-term care prevention programs and the expansion of Kayoino-ba initiatives across municipalities. They may also help municipal officials and health professionals implement effective, community-based care prevention strategies.

In summary, we clarified the relationship between roles and Ikigai among participants in Independent group activities (Kayoino-ba) for health promotion and the prevention of long-term care. It demonstrated that older adults with roles in group activities exhibited higher Ikigai, less frailty, and superior physical and mental functioning compared to those without roles. And indicated that the presence of roles is independently associated with Ikigai. These findings may assist local government officials and healthcare professionals in promoting effective community-based preventive long-term care strategies.

Funding

This work was partially supported by special research grants from Tohto University and Shizuoka Sangyo University.

Conflict of interest

The authors declare no conflicts of interest.