Social Inclusion Studies

Theme Leader :
Kae Ito, M.D., Ph.D.
Researcher :
Shuji Tsuda, M.D., Ph.D., M.P.H., Kazunori Kikuchi, C.S.W., M.A., Tomoko Ikeuchi, Ph.D.
Adjunct Researcher :
Mayuko Ono, M.A., Ayumi Hida, M.D., Ph.D., Attorney at Law., Yan Zi, Ph.D.

Social Inclusion, Health Equity, Dementia Care in the Community, Clinical Ethics, Advocacy, Multidisciplinary Care, Social Work, Well-being, End of life

1. 1.Studies on the psychosocial health of community-dwelling older adults living in complex and difficult situations
2. 2.Studies on community support systems for older adults with diverse and complex care needs

Our research focuses on older adults who face complex and challenging circumstances that often lead to social marginalization. Our mission is to provide solutions for the community support system to support the diverse needs of these individuals. Through a series of research projects in our lab, we explore the perceptions and behaviors of older adults that may impede their access to support, as well as the factors that will enable community support systems to effectively meet their needs.


1. Studies on the psychosocial health of community-dwelling older adults living in complex and difficult situations

1-1 Older adults with high psychological resistance to receiving support
Some older adults are unconnected from social resources that are objectively considered necessary. This can be due to various factors, such as poor access to information, lack of networks to facilitate usage of social resources, and socioeconomic factors. We focus on psychological resistance to receiving support, which is considered to be one of the factors that hinder the use of necessary social resources.

Social health of older men who live with dementia who have limited human relationships in the community
Support for community-dwelling older adults to realize a life that is true to themselves until the end of their lives
Strong sense of independence among self-reliant older Japanese adults

1-2 Psychological health of older adults
The following two studies focus on the relationship between the psychological health and identity of older adults. Erikson (1980) recognized integrity as a component of psychosocial development in old age and hopelessness and loneliness as indicators of a psychosocial crisis. Since his Theory of Psychosocial Development was published in the middle of the 20th century, both life expectancy and healthy life expectancy have increased dramatically.
Nonetheless, in old age, neither illness and disability nor death can be avoided. When considering the psychological health of older adults, we believe it is necessary to accumulate knowledge about the identity of today’s older adults, who live to an extended age while coping with physical and cognitive declines.

Age identity and future time perspectives
Gratitude in older adults


2. Studies on community support systems for older adults with diverse and complex care needs

2-1 Education and support for healthcare professionals involved in community-based dementia support systems
The report published by the Alzheimer’s Disease International in 2022 begins with the sentence, “We should not encourage people to have a diagnosis if post-diagnostic support is not available.” Timely provision of appropriate post-diagnosis support is a key challenge in dementia care. In the following projects, we will propose updated roles of healthcare professionals in community-based dementia care, and effective systems for providing post-diagnosis support that realizes the full potential of each professional.

Community-based post-diagnosis support for dementia
Study on adult guardianship systems

2-2 Community-dwelling older adults with complex support needs
Although responding to the needs for support of older adults living in complex and difficult situations is a significant challenge in community-based comprehensive support systems, there has been a lack of systematic research in this area. Healthcare professionals may refer to older adults living in complex and difficult situations as “difficult cases” when they find it challenging to provide support based on their own perspectives. The perceived difficulty in providing support often depends on the healthcare professional’s level of experience and expertise. However, defining such cases solely from the healthcare professional’s perspective may result in the provision of only those services that are easy for them to offer. Redefining the phrase from the perspective of the older adults and conducting studies on how to accommodate their needs and improve their well-being is essential.

Study on outreach support systems for older adults with dementia and other illnesses who live in complex and difficult situations
Study on older adults with dementia who go missing

1. 1. Ito K. Social isolation of older people in the field of community mental health. Japanese J of Geriatric Psychiatry. 2023;34(4):154-160.
2. 2. Ito K, Okamura T, Tsuda S, Ogisawa F, Awata S. Characteristics of complex cases of community-dwelling older people with cognitive impairment: A classification and its relationships to clinical stages of dementia. Geriatr Gerontol Int. 2022;22:997-1004. doi: 10.1111/ggi.14494
3. 3. Ito K. Support for the decision making involvement of people with severe mental disorders. Japanese J of Geriatric Psychiatry. 2022;33(1):64-70.
4. 4. Ito K, Okamura T, Tsuda S, Awata S. Diogenes syndrome in a 10-year retrospective observational study: An elderly case series in Tokyo. Int J Geriatr Psychiatry. 2022;37(1). doi:10.1002/gps.5635
5. 5. Ito K, Okamura T, Awata S, et al. Factors associated with psychological well-being among nonagenarians: Well-being in the era of 100 years of life. Geriatr Gerontol Int. 2022;22(4):364-366. doi:10.1111/ggi.14359
6. 6. Kikuchi K, Ooguchi T, Ikeuchi T, Awata S. Exploratory study on the factors related with the early detection of missing older persons with dementia living alone in Japan. Geriatr Gerontol Int. 2023;23(5):362-365. DOI: 10.1111/ggi.14580
7. 7. Kikuchi K, Ooguchi T, Ikeuchi T, Ito K, Awata S. Current status and issues of missing older persons with dementia living alone in Japan. Geriatr Gerontol Int. 2022;22(8):684-686. doi:10.1111/ggi.14434
8. 8. Kikuchi K, Ooguchi T, Ikeuchi T, Awata S. Missing older persons with dementia living alone-Report of 150 cases-. Japanese Journal of Geriatric Psychiatry. 2021;32(4):469-479.
9. 9. Kikuchi K, Ijuin M, Awata S, Suzuki T. Exploratory research on outcomes for individuals missing through dementia wandering in Japan. Geriatr Gerontol Int. 2019;19(9):902-906. doi:10.1111/ggi.13738
10. 10. Ikeuchi T, Ono M, Osada H. A Mini-review of extreme self-reliant behavior of older Japanese adults in interpersonal relationships. Applied gerontology. 2022;16(1):89-98.
11. 11. Ikeuchi T, Taniguchi Y, Abe T, et al. Pet Ownership and the Future Time Perspective of Older Adults. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry. 2022;35(4):226-233. doi:10.1024/1662-9647/a000298
12. 12. Ikeuchi T, Taniguchi Y, Abe T, et al. Association between Experience of Pet Ownership and Psychological Health among Socially Isolated and Non-Isolated Older Adults. Animals. 2021;11(3):595. doi:10.3390/ani11030595
13. 13. Tsuda S, Matsumoto H, Takehara S, Yabuki T, Hotta S. Family caregiver's concerns and anxiety about unaccompanied out-of-home activities of persons with cognitive impairment. BMC Geriatrics. (In press)
14. 14. Tsuda S, Inagaki H, Sugiyama M, et al. Living alone, cognitive function, and well-being of Japanese older men and women: a cross-sectional study. Health Soc Care Community. 2023;7183821. doi:10.1155/2023/7183821
15. 15. Tsuda S, Jinno M, Hotta S. Exploring the meaning of journal writing in people living with dementia: a qualitative study. Psychogeriatrics. 2022;22(5):699-706. doi:10.1111/psyg.12872
16. 16. Tsuda S, Inagaki H, Okamura T, et al. Promoting Cultural Change Towards Dementia Friendly Communities: A Multi-level Intervention in Japan. BMC Geriatrics. 2022;22:360. doi:10.1186/s12877-022-03030-6
17. 17. Ono M, Fujino H, Yokoi Y, Osada H. Review of studies about gratitude in older adults: Focusing on the association of gratitude with well-being and mental health. Applied gerontology. 2021;15(1):75-85.