Introduction to Japan Gerontological Evaluation Study (JAGES)

The Japan Gerontological Evaluation Study (JAGES) is a research project that aims to build a scientific foundation for preventive policies toward achieving a society of healthy longevity. In the 2022 survey, JAGES collaborated with 76 municipalities across 23 prefectures nationwide and conducted a survey of older adults who were not certified as requiring long-term care. Approximately 230,000 older adults responded to the survey (including those conducted in fiscal year 2023).

Researchers affiliated with more than 60 institutions, including universities and national research institutes throughout Japan, are conducting multifaceted analyses. The project is supported by numerous research grants from organizations such as the Ministry of Education, Culture, Sports, Science and Technology (Japan), the Ministry of Health, Labor and Welfare (Japan), and the U.S. National Institutes of Health (NIH).

History: Development from AGES to JAGES
The Aichi Gerontological Evaluation Study (AGES) project was initiated in 1999, which conducted a survey in two municipalities of Aichi Prefecture. The goal of the survey was to obtain scientific knowledge that would form the basis of the elderly care policy. We emphasized on the following three aspects:

• Promoting evidence-based, gerontological research focusing on adults aged 65 and above, from a multidisciplinary viewpoint, including physiology, psychology, and sociology;
• Promoting social epidemiological research that helps address social determinants of health (SDHs); and
• Developing a comprehensive benchmark system for the preventive care policy, as well as contributing to achieve a society of health and longevity characterized by a high level of well-being and a small level of health inequality, which would be assessed through regional interventional studies.

In 2003, surveys were conducted in 15 municipalities across three prefectures, targeting approximately 33,000 older adults who had not been certified as needing long-term care. In 2006, follow-up surveys were carried out in 10 municipalities in the same three prefectures that agreed to participate. In 2010, with an expansion to about 100,000 respondents in 31 municipalities nationwide, the work developed into the JAGES (Japan Gerontological Evaluation Study) project. We subsequently collected data from about 140,000 people in 30 municipalities nationwide in fiscal year 2013, and about 200,000 people in 41 municipalities in fiscal year 2016. Researchers from a variety of fields—not only epidemiology but also economics and urban/regional planning—have been involved in questionnaire design and data analysis.

Since 1999, over roughly two decades, we have not only conducted research but also provided support to municipalities, offered policy recommendations, and developed policy management support systems, achieving tangible results. During this period, we operated as a voluntary organization— a network of researchers affiliated with more than 30 universities and national research centers. To further advance our activities, in 2018 we established the Japan Agency for Gerontological Evaluation Study (General Incorporated Association).

Photograph of the fifth anniversary of CWS and the fifteenth anniversary of AGES	JAGES Summer Camp in 2015, photographed in August 2015

Research objectives of JAGES

Japan has the highest life expectancy in the world. The JAGES project aims to improve the status quo of adults aged 65 and above in Japan from a multifaceted viewpoint. In this project, we wish to shed light on the following key areas:

1. To elucidate the “social determinants of health”
   When considering the risk factors of one’s health, we need to analyze not only lifestyle such as diet, exercise, smoking, and drinking, but also one’s psychological and social factors. We aim to demonstrate the significance of social epidemiology to elucidate the “social determinants of health,” such as income and educational background.
   
   
2. To describe “health inequality”
   We have found health inequality is prevalent among Japanese adults aged 65 and above. Health inequality originates from socioeconomic factors and regional inequality in access to social services. We are also working to “visualize” and minimize health inequality among Japanese adults aged 65 and above, a national initiative for health promotion advocated in “Health Japan 21 (the second term)” by the Ministry of Health, Labour and Welfare.
   
   
3. To show the direction of renewed strategies for preventive care
   With the recent amendment of the long-term care insurance system, preventive care has increasingly been emphasized. In accordance with this movement, depression, oral care, malnutrition, the likelihood of fall, lifestyle, and social seclusion are now considered important factors for preventive care. In addition, more attention has been given to the underlying social determinants of health, such as insomnia, hobbies, abuse, household structure, participation in community organizations, social support, occupational status, and social capital. We are examining the relationship between these various factors/determinants and the socioeconomic status of adults aged 65 and above, as well as the effect of regional differences in their living conditions.
   We do not hope to choose a strategy that screens adults aged 65 and above receiving long-term care insurance or those with a high risk of mortality (high-risk approach). Instead, by paying attention to environmental factors, we intend to clarify the significance of taking measures for preventive care that targets all community residents, including those with no/low risk of death (population approach).
   Furthermore, we are currently working on interventional studies at a regional level in collaboration with municipalities across Japan.

Outline of the JAGES Project

Large-Scale Social Epidemiological Survey

Research subjects
Adults aged 65 and above who have not received long-term care insurance

Research method
Questionnaires are mailed and responses are collected.

Survey periods and “waves”
In JAGES, a consolidated set of surveys conducted across multiple study areas during the same period using the same core questionnaire is called a “wave.”

Wave I (data from the 2003 survey): 
Survey conducted in 15 municipalities of 3 prefectures (12long-term care insurers) from 2003 to 2004

Wave II (data from the 2006 survey): 
Survey conducted in 9 municipalities of 3 prefectures (9 long-term careinsurers) from 2006 to 2007

Wave III (data from the 2010 survey):
 Survey conducted in 31 municipalities of 12 prefectures (25 long-termcare insurers) from 2010 to 2011

Wave IV (data from the 2013 survey): 
Survey conducted in 30 municipalities of 14 prefectures (25 long-term careinsurers) in 2013

Wave V (data from the 2016 survey):
Survey conducted in 40 municipalities of 18 prefectures (35 long-term careinsurers) in 2016–2017

Wave VI (data from the 2019 survey):
Survey conducted in 66 municipalities of 27 prefectures (59 long-term careinsurers) in 2019–2020

Wave VII (data from the 2022 survey):
Survey conducted in 76 municipalities of 23 prefectures (67 long-term careinsurers) in 2022–2023

*The preliminary survey below (i.e., data from the 2000survey) is treated as exceptional.Wave 0: A preliminary survey done in twomunicipalities of one prefecture (two long-term care insurers) from 1999 to2000

Survey items (in the 2022 survey)
Each participant received one randomly assigned version of a 16-page questionnaire booklet, selected from eight versions (modules) labeled A–H. For research analyses, we used (i) eight pages of “core items” answered by all respondents, including factors related to long-term care prevention and key confounders; (ii) two pages of “sub-core” items important for community diagnosis; and (iii) two pages of “version-specific items,” in which eight exploratory modules were evenly allocated across versions.

This document was translated into English using artificial intelligence