Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis
[THE COMPLETE ARTICLE READ IN FULL AT SOURCE at the PubMed Central record, including Table 2 in full, the Research in Context panel, the subgroup discussion, the bidirectionality analysis, all nine stated limitations and the conclusion. The publisher's own fulltext URL returned an empty body and was not the read used] Okuzono, S. S., and colleagues (2022). 'Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis.' The Lancet Regional Health, Western Pacific, 21, 100391. doi:10.1016/j.lanwpc.2022.100391. PMID 35141667. PMC8814687. Okuzono is first author, confirmed at the PMC author list. THE NULL, AND THE MEASUREMENT CRITIQUE IN THE AUTHORS' ACCOUNT. DESIGN: Japan Gerontological Evaluation Study, a nationwide longitudinal study of adults aged 65 and over; ikigai measured in 2013, outcomes in 2016, across two databases, n = 6,441 and n = 8,041, with n = 8,951 for all-cause mortality, functional disabilities and dementia; models adjust for the 2010 pre-baseline values of the outcomes themselves to address reverse causation. Funded by NIH, the John Templeton Foundation and several Japanese agencies; no competing interests declared. THE MEASURE: respondents reported whether they had ikigai in their life at the time of the 2013 survey, with a binary yes or no answer. THE NULL: all-cause mortality RR 0.85, 95 per cent CI 0.60 to 1.19, p = 0.328, marked N.S. THE CORRECT CHARACTERISATION, FROM THEIR OWN LIMITATIONS: the fourth notes the three-year follow-up may have been too short and that only 6 per cent of the analytic sample (n = 506) died in it; the fifth notes that their estimate is in line with many prior studies while its confidence interval is wider and includes the null. THIS IS AN UNDERPOWERED NULL COMPATIBLE WITH THE EARLIER COHORTS, NOT A REFUTATION OF THEM, and 0.85 is almost exactly Tanno's estimate for men. SIGNIFICANT FINDINGS from the same table: functional disability any level 0.69 (0.58-0.82); level 1 or greater 0.67 (0.54-0.83); level 2 or greater 0.71 (0.53-0.96); need support 0.70 (0.54-0.92); dementia 0.64 (0.48-0.85); sedentary lifestyle 0.62 (0.42-0.92); insomnia 0.55 (0.34-0.89) on a much smaller sub-sample of n = 821; depressive symptoms standardised difference -0.58 (-0.68 to -0.48); hopelessness 0.43 (0.37-0.51), the largest effect in the table; happiness 0.43 (0.33-0.52); life satisfaction 1.14 (1.09-1.21); instrumental activities of daily living 0.19 (0.10-0.28); hobby-club participation 0.19 (0.09-0.28); sharing skills and experiences 0.17 (0.08-0.26). THE OTHER NULLS, WHICH MATTER JUST AS MUCH: no remaining natural teeth 0.92 N.S.; good self-rated health 1.05, p = 0.070, N.S.; current smoker 1.10 N.S.; body mass index 0.01 N.S.; flu shot 1.00 N.S.; health check-up attendance 1.03 N.S.; senior-club participation N.S.; frequency of meeting friends N.S.; care social support N.S.; AND FREQUENCY OF VOLUNTEERING 0.07, p = 0.201, N.S., which is the closest thing in the table to the diagram's 'what the world needs' circle and did not move. THE MEASUREMENT CRITIQUE, first of nine limitations: the ikigai measure was a single binary item, whereas Sone and colleagues used a three-option question (yes, uncertain, no) in which 36.4% of an analytic sample of 43,391 answered uncertain, which suggests the binary measure is prone to misclassification; the measure also cannot capture varying levels of ikigai or its sources, which can hide heterogeneity in the effects. They call for future studies to collect information on the kinds of activities from which people derive ikigai. HETEROGENEITY: benefit concentrated in men and in those of higher socioeconomic status, which the authors flag and say they cannot explain, offering patriarchal values embedded in Japanese society only as a possibility. BIDIRECTIONALITY: lower pre-baseline depressive symptoms predicted having ikigai later, as did lower hopelessness, while none of the other pre-baseline outcome levels strongly predicted it. Conclusion: having ikigai may lead to lower psychological distress and better subjective wellbeing among older Japanese adults, and to better physical health among older Japanese men and those of high socioeconomic status. Observational throughout.
[THE COMPLETE ARTICLE READ IN FULL AT SOURCE at the PubMed Central record, including Table 2 in full, the Research in Context panel, the subgroup discussion, the bidirectionality analysis, all nine stated limitations and the conclusion. The publisher's own fulltext URL returned an empty body and was not the read used] Okuzono, S. S., and colleagues (2022). 'Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis.' The Lancet Regional Health, Western Pacific, 21, 100391. doi:10.1016/j.lanwpc.2022.100391. PMID 35141667. PMC8814687. Okuzono is first author, confirmed at the PMC author list. THE NULL, AND THE MEASUREMENT CRITIQUE IN THE AUTHORS' ACCOUNT. DESIGN: Japan Gerontological Evaluation Study, a nationwide longitudinal study of adults aged 65 and over; ikigai measured in 2013, outcomes in 2016, across two databases, n = 6,441 and n = 8,041, with n = 8,951 for all-cause mortality, functional disabilities and dementia; models adjust for the 2010 pre-baseline values of the outcomes themselves to address reverse causation. Funded by NIH, the John Templeton Foundation and several Japanese agencies; no competing interests declared. THE MEASURE: respondents reported whether they had ikigai in their life at the time of the 2013 survey, with a binary yes or no answer. THE NULL: all-cause mortality RR 0.85, 95 per cent CI 0.60 to 1.19, p = 0.328, marked N.S. THE CORRECT CHARACTERISATION, FROM THEIR OWN LIMITATIONS: the fourth notes the three-year follow-up may have been too short and that only 6 per cent of the analytic sample (n = 506) died in it; the fifth notes that their estimate is in line with many prior studies while its confidence interval is wider and includes the null. THIS IS AN UNDERPOWERED NULL COMPATIBLE WITH THE EARLIER COHORTS, NOT A REFUTATION OF THEM, and 0.85 is almost exactly Tanno's estimate for men. SIGNIFICANT FINDINGS from the same table: functional disability any level 0.69 (0.58-0.82); level 1 or greater 0.67 (0.54-0.83); level 2 or greater 0.71 (0.53-0.96); need support 0.70 (0.54-0.92); dementia 0.64 (0.48-0.85); sedentary lifestyle 0.62 (0.42-0.92); insomnia 0.55 (0.34-0.89) on a much smaller sub-sample of n = 821; depressive symptoms standardised difference -0.58 (-0.68 to -0.48); hopelessness 0.43 (0.37-0.51), the largest effect in the table; happiness 0.43 (0.33-0.52); life satisfaction 1.14 (1.09-1.21); instrumental activities of daily living 0.19 (0.10-0.28); hobby-club participation 0.19 (0.09-0.28); sharing skills and experiences 0.17 (0.08-0.26). THE OTHER NULLS, WHICH MATTER JUST AS MUCH: no remaining natural teeth 0.92 N.S.; good self-rated health 1.05, p = 0.070, N.S.; current smoker 1.10 N.S.; body mass index 0.01 N.S.; flu shot 1.00 N.S.; health check-up attendance 1.03 N.S.; senior-club participation N.S.; frequency of meeting friends N.S.; care social support N.S.; AND FREQUENCY OF VOLUNTEERING 0.07, p = 0.201, N.S., which is the closest thing in the table to the diagram's 'what the world needs' circle and did not move. THE MEASUREMENT CRITIQUE, first of nine limitations: the ikigai measure was a single binary item, whereas Sone and colleagues used a three-option question (yes, uncertain, no) in which 36.4% of an analytic sample of 43,391 answered uncertain, which suggests the binary measure is prone to misclassification; the measure also cannot capture varying levels of ikigai or its sources, which can hide heterogeneity in the effects. They call for future studies to collect information on the kinds of activities from which people derive ikigai. HETEROGENEITY: benefit concentrated in men and in those of higher socioeconomic status, which the authors flag and say they cannot explain, offering patriarchal values embedded in Japanese society only as a possibility. BIDIRECTIONALITY: lower pre-baseline depressive symptoms predicted having ikigai later, as did lower hopelessness, while none of the other pre-baseline outcome levels strongly predicted it. Conclusion: having ikigai may lead to lower psychological distress and better subjective wellbeing among older Japanese adults, and to better physical health among older Japanese men and those of high socioeconomic status. Observational throughout.
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The Lancet Regional Health - Western Pacific, 21, 100391. doi:10.1016/j.lanwpc.2022.100391