Examining apathy prevalence and associated factors among older adults after the Great East Japan Earthquake: A mixed-methods study

Examining apathy prevalence and associated factors among older adults after the Great East Japan Earthquake: A mixed-methods study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Examining apathy prevalence and associated factors among older adults after the Great East Japan Earthquake: A mixed-methods study Mari Yamashita, Satoshi Seino, Yu Nofuji, Yasuhiro Sugawara, Tsuyoshi Okamura, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3896354/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Background This study aimed to clarify the sense of apathy experienced by older adults residing in areas affected by the Great East Japan Earthquake (GEJE) in 2011 and categorized the factors associated with apathy based on their narratives. Methods A triangulation-mixed-method sequential explanatory design was employed. Data were collected using a mail survey among 9754 randomly selected community-dwelling independent adults, aged between 65–84 years, living in Kesennuma City, one of the GEJE-affected areas, in October 2019. Of these, 7845 completed the analysis criteria, and participants who scored ≥ 2 on three apathy items of the Geriatric Depression Scale were considered to have apathy. A thematic analysis was performed on the narrative data obtained to categorize the associated factors. Results The mail survey results indicated that apathy had a prevalence of 44.2%. Using data from 30 individuals who demonstrated apathy during the interview, the thematic analysis revealed three types of apathy: (A) Decline , caused by decreased physical and social functioning due to aging or illness; (B) Crisis , caused by major life-changing events, such as bereavement, divorce, unexpected retirement, or disaster; and (C) Carry Over , caused by strained family relationships and stressful social situations during old age. Conclusions In addressing apathy, it is important to check for the co-occurrence of depression, life satisfaction, and the availability and utilization of social support. apathy mixed-methods study Great East Japan Earthquake Figures Figure 1 Background The Great East Japan Earthquake (GEJE) in 2011 and the subsequent tsunami have had long-term health consequences, including an increased prevalence of sleep disorders and mental disabilities [1–4]. Addressing the psychosocial problems caused by the GEJE is an urgent issue relevant to health policies dealing with older adults in affected areas. Apathy, a psychosocial problem, refers to impaired motivation and is a clinically significant syndrome associated with a decline in physical, cognitive, and daily functioning [5]. However, apathy in older adults is often confused with symptoms also associated with dementia, strokes, and mood disorders such as depression [6]. The actual condition of apathy in older adults living in the affected areas is not sufficiently clear, and the factors associated with it are unknown. Therefore, this study aimed to determine the actual condition of apathy among older adults living in the affected areas using a large-scale mail survey and identify its associated factors. Specifically, epidemiological surveys and statistical methods were used to clarify the prevalence of apathy and its associated factors. In addition, to gain a more detailed understanding of the actual condition and background factors of apathy, interviews were conducted with individuals who demonstrated apathy and limited health behaviors. Specifically, older adults with apathy who did not participate in any social activities were asked about the events preceding their apathy and how they perceived their condition, and their narratives were categorized. Social activity is one of the health behaviors associated with life expectancy and cognitive function in older adults [7–9]. By clarifying the actual conditions and factors of apathy, we can consider measures to improve people’s mental health in the affected areas. For this purpose, our study was positioned as a foundational document. Materials and Methods Study design and sampling This study employed a triangulation mixed-method sequential explanatory design [10]. First, in October 2019, a mail survey was conducted in Kesennuma City, one of the affected areas, involving 9754 independent older adults aged 65–84 years. Responses were received from 7845 individuals (80.4% collection rate) [11]. Subsequently, 5012 questionnaires with no missing data were selected for the analysis. Those returning the mail survey who met the criteria for apathy, had no interest in participating in social activities, and gave permission to be contacted by telephone were asked to respond via an interview survey (Figure 1). [Figure 1 near here] Mail survey Primary outcome Apathy was assessed using three apathy items of the Geriatric Depression Scale (GDS-3A). A score of two or more was considered to demonstrate apathy [12]. Secondary outcome Basic information such as sex, age, residential status, and marital status were used, as well as socioeconomic status such as education and income; medical profiles such as subjective health and medical history; frailty; body mass index (BMI); subjective cognitive function and mobility limitations; lifestyle habits such as exercise, smoking, drinking, going out and participating in social activities, and depression [13,14]. Regarding participation in social activities, we inquired about the frequency of participation in volunteer activities, sports, hobbies, educational activities, neighborhood associations, and senior citizen clubs using the following choices: “more than once a week,” “1 to 3 times a month,” “several times a year,” and “do not participate.” Telephone survey Those who returned the mail survey and met the following criteria were asked to participate in the interview survey: 1) those who met the criteria for apathy; 2) those who did not participate in any social activities such as volunteer work, hobbies and study groups, exercise groups, neighborhood associations and community associations, senior citizen salons, and senior citizen clubs; 3) those who had no interest in social activities; and 4) those who gave their consent to be called. In response to the question, “What kind of group social activities would you like to participate in if there were any in your neighborhood?” the options were handicrafts, painting/picture writing, board games, photography, travel, getting close to nature, exercises, singing, watching films, tea parties, dinner parties, cooking and eating together, health promotion classes, and others, and those who answered that they were not interested in participating, regardless of the content of the activity. Those who answered that they did not want to participate, regardless of the content, were considered to have no interest in social activities. A semi-structured interview survey was conducted by the first author (MY), a clinical psychologist. The questions were decided based on prior expert brainstorming, and an interview guide was prepared (Table 1). For example, regarding life history, we asked the participants “Looking back on your life, what was your happiest period?” This also primed interviewees to return and talk about the past. Similarly, we asked about their current state of apathy, followed by the question, “When did you become demotivated as you are now?” and encouraged them to actively talk about their perceptions and history of apathy. In this way, the interviewer not only tried to listen but also made appropriate facilitative remarks to encourage the story to develop. The audio data were recorded using a telephone recorder (StickPhone 8G). In principle, considering the burden on the participant, the number of telephone surveys was conducted once per participant; however, if the interview time was long, it was divided into two sessions. Table 1. Telephone interview questions Basic profiles and lifestyle Family structure, how they spend their day, life satisfaction (on a scale of 0–100). Perceptions of own apathy GDS-3A, “When did you become as demotivated as you are now?” “How do you feel about this?” Social participation Participation in social activities, reasons for not participating in social activities. Life history “Looking back on your life, what was your happiest period?” Social support Convoy model [15], “Do you have someone you can talk to if you have any problem?” Note: GDS-3A: Geriatric Depression Scale Analysis procedure Regarding quantitative data from the mail survey, the secondary outcomes were compared according to the presence or absence of apathy. The chi-square test was used for categorical variables, and the Kruskal–Wallis test was used for continuous variables. In addition, the analysis was conducted using Poisson regression analysis for men and women separately, with apathy present as the objective variable and secondary outcomes as the independent variables. We calculated the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for apathy. Data were analyzed using Stata 16.0 (Stata Corp, LLC, College Station, TX, USA), and statistical significance was set at p = 0.05. For the qualitative data from the interviews, a thematic analysis was used to identify themes that emerged in the narratives and establish meaningful categories [16]. First, the audio data were transcribed verbatim to extract narratives that reflected their own perceptions of apathy, such as how they developed a sense of apathy and what they thought about it. The narratives of one person were interpreted as a cohesive group and assigned code names that reflected the individual’s themes. Data from the second person were interpreted in comparison with the code name assigned to the first person; if they had similar codes, they were classified into an existing code, and if different, a new code name was created. The same procedure was followed for the third and subsequent participants. In addition, codes were categorized according to their closeness and thematic names. The codes were generated by the first author alone, but the interpretation of the data, categorization process, and consistency of the thematic names was decided in consultation with the co-authors. Supervision was provided by a researcher with expertise in gerontology where appropriate, and efforts were made to avoid biased interpretation. Furthermore, to prevent divergence between themes and narratives, the analysis software MAXQDA Analytics Pro 18 was used to check the consistency of the transcripts. Ethical consideration This study was approved by the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology. Written informed consent was obtained from all the participants. Results Subject profile in mail survey The number and prevalence of apathy was 2,214 (44.2%) in total: 985 (44.5%) in men and 1,229 (55.5%) in women, with significantly more women (p<0.05). Table S1 shows the results for men (see Additional File 1), and Table S2 shows the results for women (see Additional File 2), comparing the basic information of the participants and related items according to the presence or absence of apathy. For both men and women, the prevalence of apathy was significantly higher in terms of age, type of residence, marital status, economic status, number of chronic diseases, BMI, mobility limitation, subjective cognitive decline, frailty, regular exercise, social participation, drinking habits, and depressive mood. For women only, in addition to the above, significant associations were also found with years of education. Background characteristics of the apathy group Table 2 presents the results of the Poisson regression analysis examining the factors associated with apathy by gender. In men, four factors were significantly associated with apathy: subjective cognitive decline, frailty, social participation, and depressive moods. In women, five factors were significantly associated with apathy, namely mobility limitations, subjective cognitive decline, frailty, social participation, and depressive mood. No other basic information, such as age, type of residence, or socioeconomic status, were found to be associated. Table 2 Items with significant associations in the Poisson regression analysis Men Women Category (Criterion group) IRR 95% CI IRR 95% CI Depressive mood (Without) With 3.05** 2.64–3.53 2.60** 2.29–2.97 Mobility limitation (Without) With 1.00 0.85–1.17 1.18* 1.03–1.35 Subjective cognitive decline (Without) With 1.15* 1.00–1.31 1.17* 1.03–1.32 Frailty (Without) With 1.32** 1.13–1.55 1.26** 1.09–1.45 Social participation (Participate) Not participate 1.28** 1.11–1.49 1.27** 1.12–1.45 Note: IRR: Incident Rate Rations, 95% CI: 95% Confident Interval, **: <0.001, *:<0.05 Perceptions of patients regarding apathy As shown in Fig. 1 , 229 mail survey respondents met the criteria for interviewees. They were asked to complete a telephone survey, and 36 agreed to be interviewed. Each interview lasted an average of 49.4 minutes (23–160 minutes). Their narratives were categorized according to familiarity, focusing on the history and perception of apathy, and were classified into three themes: (a) Decline, (b) Crisis, and (c) Carry Over. Table 3 shows a description of the themes, codes, and examples of narratives. Table 3 Themes regarding apathy found in narratives Thema Explanation Code Narrative A. Decline (n = 21) They had a common awareness that with age, they were gradually losing their energy—there exists a change in consciousness that makes us more aware of aging. For example, there was a decline in physical function, or a decline in life function, such as not being able to do things well. Lacking the will to do something and being reluctant to act on things was a theme they shared. A-1. Declining physical functions “I have trouble seeing and don't feel like doing anything. Well, I'm getting old, so I think it's normal to be like this.” A-2. Decreasing self-imposed standards with age “With age, I become less strict with myself. For example, when I try to cook for myself, I often switch to something simpler.” A-3. Declining life function and self-confidence “I've lost my will. When I was in my 60s, I was always trying new things, but as I approached my 70s, I began to give up and think that nothing I did was worth it. Up until now, I've been able to make sauces for food perfectly, but I'm not confident, or rather, I'm gradually not being able to do it well.” B. Crisis (n = 7) They believed their apathy was caused by major life changes. For example, they talked about devastating life events such as a serious life-threatening illness, bereavement of a spouse, divorce, sudden retirement, the shock of an earthquake, and moving house. Bereavement and retirement may or may not be directly related to the disaster. B-1. Serious illness and lack of security “I can't imagine being interested in new things after being sick. I am living in the dimension of whether I will be able to live tomorrow so I don't have any plans or motivation for tomorrow. There are many people like me. I understand that there is nothing I can do about it, even if I think about it myself, so I don't feel anything.” B-2. Widowed and no competition “After my wife passed away, I lost my sense of purpose. I'm just waiting for the time I die. I stay at home most of the time and no longer feel like going out.” B-3. The shocked by GEJE “The earthquake was a huge shock to me. There was a period when I didn't even step out of my house. After that, things started to go wrong, and I had no energy. Somehow, I feel that no matter how hard I try, everything will be nothing in the end.” B-4. Sudden retirement “I lost my job as a fisherman in the earthquake. When I was working, I had a boat, so I used to go fishing even on my days off. My ship was washed away by the earthquake, and I no longer had the desire to buy a new one. From then on, all the things that were fun started to seem troublesome.” C. Carry Over (n = 2) They had long felt low motivation even before old age. They also had strained family relationships and stressful social situations, such as debt, for long periods of time. C-1. Long-term isolation “No money, no family connections. My parents passed away early, and I never thought about whether I was happy or not. I always have a feeling of giving up on life because things might not get better.” C-2. Long-term hardship “I've been unmotivated for longer than I can remember. I'm so busy living. To be honest, I'm in my old age and want to take it easy without working, but if I don't work, I'll starve to death tomorrow. My daughter is disabled, so she cannot work. That's why it's hard. I must go because I can't help it—I just have to do it. I come home exhausted and don't have the energy to do anything. My life has been like that all along.” [Table 3 near here] Comparison of thematic features behind apathy To further examine the characteristics of each theme identified in the qualitative analysis, the results of the mail and telephone surveys are tabulated by theme and presented in Table 4 . Although statistical comparisons cannot be made owing to the presence of themes with a small number of respondents, the characteristics of each theme are described. Table 4 Cross-tabulation by theme for mail and telephone surveys Total n = 30 Decline n = 21 Crisis n = 7 Carry Over n = 2 Mail survey Sex Men, n (%) 18 (60.0) 11 (52.4) 6 (85.7) 1 (50.0) Age Mean (SD) 73.5 (1.0) 74.9 (5.6) 69.7 (1.3) 72.5 (4.5) Living alone Yes, n (%) 9 (30.0) 7 (33.3) 2 (28.6) 0 (0.0) Depression mood With, n (%) 21 (72.4) 15 (71.4) 5(83.3) 1 (50.0) Mobility limitation With, n (%) 18 (60.0) 13 (61.9) 4 (57.1) 1 (50.0) Subjective cognitive decline With, n (%) 11 (36.7) 9 (42.9) 1 (14.3) 1 (50.0) Frailty With, n (%) 14 (46.7) 9 (42.9) 3 (42.9) 2 (100.0) Telephone survey Life satisfaction (0-100) Mean (Min-Max) 72.3 (10–100) 78.3 (50–100) 58.6 (10–100) 50.0 (50–50) The happiest period Present, n (%) 7 (23.3) 7 (33.3) 0 (0.0) 0 (0.0) Past, n (%) 21 (70.0) 14 (66.7) 7 (100.0) 0 (0.0) Never, n (%) 2 (6.7) 0 (0.0) 0 (0.0) 2 (100.0) Social support, n (%) Not isolated, and consulted 19 (63.3) 16 (76.2) 3 (42.9) 0 (0.0) Not isolated, but not consulted 8 (26.7) 4 (19.0) 3 (42.9) 1 (50.0) Isolated, and not consulted 3 (10.0) 1 (4.8) 1 (14.3) 1 (50.0) Note : Social participation is not included in this table, as not participating in social activity is a selection criterion. In the Decline type, the proportion of men and women was half, the average age was slightly older (74.9 years), and the proportion of those with subjective cognitive decline was 42.9%. The average life satisfaction score was relatively high at 78.3 points, and 33.3% of the respondents indicated “now” as the best time in their lives. Furthermore, 76.2% said that they had someone to talk to in times of trouble. The Crisis type was a relatively young group, with 85.7% being male and an average age of 69.7 years. Only one participant had subjective cognitive impairment. A high proportion (83.3%) had depressed mood, and the mean score for life satisfaction was low (58.6 points). Regarding the best period in their lives, all respondents answered “past.” Furthermore, more respondents said that they had family, friends, or other people close to them whom they could rely on but would not actually consult them, or that they had no one with whom they could consult, than those who said they had someone with whom they could and did consult. The reasons given for not consulting were that they had to solve the problem themselves. The Carry Over type consisted of one man and woman, both of whom lived with family members. Both fell into the frail category and had a life satisfaction score of 50. Both respondents stated that the best period in their lives was “never.” Furthermore, none of the respondents said that they had someone to talk to or discuss their problems with. [Table 4 near here] Discussion Actual condition of apathy in the affected areas The results of the mail survey revealed that approximately 44.2% of older adults living in the affected areas demonstrated apathy. Previous studies have reported a prevalence of apathy of approximately 20–26% among older people living in the affected areas [ 6 , 17 ], and the prevalence of apathy in this study was higher by comparison. In this study, cross-tabulations showed a trend toward a higher incidence in older age groups, which was consistent with previous studies [ 17 ]. However, there was no direct association between age and apathy as the effect of age became less significant after adjusting for other relevant factors. Regarding factors associated with apathy after adjusting for basic information, depressive mood, subjective cognitive decline, frailty, and social participation were common for both men and women. In this study, nearly 70% of those with apathy were also depressed, suggesting that apathy and depressed mood have a high overlap. The results of the Poisson regression analysis suggested that being depressed was approximately three times more likely to be associated with apathy in men and 2.6 times more likely in women. However, around 30% demonstrated apathy only, indicating that it does not necessarily occur simultaneously with depression. Apathy is a common symptom in individuals with dementia and is likely to be a precursor to dementia [ 18 – 19 ]. Although this study did not measure objective cognitive decline, and the causal relationship is unknown, subjective cognitive decline was found to be associated with apathy. Subjective cognitive decline is considered the earliest identifiable symptom of cognitive impairment [ 20 ] and may be associated with apathy, which is also an early symptom. In addition, although there were few direct references to forgetfulness in the telephone survey, some respondents reported declining life functioning, such as “I cannot cook well anymore, and I have lost confidence.” It has been suggested that cognitive decline and related problems in daily life may increase apathy. The association between frailty and apathy shown in this study is consistent with previous research [ 17 ]. However, frailty is an indicator of overall health, that is, not only physical functioning, but also nutritional status and social functioning—this mail survey does not tell us which functions are specifically associated with apathy. In the telephone survey, some Decline type participants reported age-related decline in physical function as a background to apathy. In contrast, Crisis and Carry Over were characterized by a decline in social function, such as not having anyone to talk to, which may differ depending on the type of apathy. In addition to the above-mentioned factors common to both sexes, only among women was there an association with mobility limitation, via a question asking about difficulties in walking and climbing stairs, difficulties that are often linked to inconvenience in daily life. It is possible that apathy is increased in women when they are forced to reduce their range of activities because of physical functional problems. Conversely, apathy may lead to inactivity in daily life and reduced mobility as the causal relationship is unclear. Consideration of intervention methods according to the type of apathy To obtain a more detailed characterization of apathy, this study analyzed qualitative data from interviews with those who were apathetic, not participating, and not interested in social activities. The results were classified into three types: Decline, Crisis, and Carry Over. The Decline type was aware of aging, said they had lost energy with age, and were in an older age group. They also spoke of a decline in physical function and a loss of confidence as they progressively became less able to do everyday things. This is also consistent with the high number of people with mobility limitations and subjective cognitive decline in the mail survey. However, considering that the average daily life satisfaction of Japanese older adults was 65.3 points out of 100 [ 21 ], it is noteworthy that the Decline type maintained a relatively high level of daily life satisfaction (78.3 points). Furthermore, a certain number of respondents stated that they were happiest at the time. One of the reasons for high daily life satisfaction and happiness despite apathy can be explained by the defense mechanisms of the mind. For example, the Decline type included those who said that they had become less demanding of themselves. They did the bare necessities of everyday life rather than doing new things or being sufficiently active. They were reluctant to put in effort, quicker to give up, and characterized by attributing this behavior to age, saying that they were too old to do anything about it. This may be explained by the socioemotional selectivity theory [ 22 , 23 ]. According to this theory, mood adjustment is the most prioritized adaptation pattern when there is little time left in life. As a result, there is a conservative tendency to continue existing activities rather than taking on the risks associated with change, with an emphasis on maintaining existing close relationships rather than establishing new ones. In other words, apathy itself may be an adaptive strategy to age-related changes. Another possible reason could be adjustment by social support. Krause [ 24 ], in a study of older adults, reported that exposure to trauma reduces life satisfaction, but that emotional support offsets that effect. In this study, the Decline type had a high percentage of opportunities for consultation, and it is possible that the harmful effects of decreased motivation were negated by receiving support from those around them. It is also possible that they compensate for the negative effects of low motivation by receiving support from their surroundings. Considering the same, the Decline type may need to pay more attention to reduced life satisfaction, lack of social support, and loss of confidence, rather than focusing on apathy itself. Measures that confirm and encourage what is currently being done may be effective. A key feature of the Crisis type is that apathy follows an experience of loss. A low level of life satisfaction suggests that apathy is accompanied by distress. Depression in older people is more likely to be triggered by loss-like events [ 25 , 26 ]. In addition, McAdams calls the telling of stories about life, where life was good in the past and is now worse, the “contamination sequence” [ 27 ]. In a study of adults, the contamination sequence was reported to be positively correlated with depression and negatively correlated with life satisfaction [ 28 ]. The results are also consistent with the fact that all Crisis types in this study cited the past as the happiest period of their lives. Considering this, we believe that in Crisis types, the presence of depression should first be ascertained, and if applicable, treatment should be recommended. However, they may also find it difficult to intervene using familiar social support, given the high proportion of participants who felt that they do not actually talk to anyone close to them. Further investigation is needed to determine which support resources are more likely to be used by Crisis types with these characteristics. The Carry Over type is characterized by long-term exposure to social stress such as deprivation and isolation over the course of their lives, which they continue to carry into old age. They exhibit low levels of life satisfaction, although the small number of respondents (n = 2) means that the figures should be interpreted with caution. It should also be noted that, although they have people living with them, they do not receive any support from them and are emotionally isolated. They are looked after less than those who live alone and may be more isolated from the rest of the family. Carry Over types require financial and welfare support to stabilize their lives. However, it is expected that they would find it difficult to connect with their social support and form lasting bonds, as they work for a living without the luxury of time and have little experience of being consulted and helped. Limitations A limitation of this study is that the results are from affected rural areas and may therefore differ from the incidence of apathy in urban and other areas. The results of this study cannot be directly applied to other regions, as the factors associated with apathy may differ according to regional characteristics. Although those with apathy were interviewed, the sampling would have been biased, as it targeted those who were willing to participate to the extent that they were willing to be interviewed. New categories can be identified by increasing the sample size. Despite the above limitations, few epidemiological studies have examined the prevalence of apathy in older adults living in the community on a large scale, revealing the factors associated with it, which could prove to be a source for future approaches. In addition, the participants interviewed in this study were a group of people who demonstrated apathy and did not usually participate in community activities, making it difficult for us to contact to them and hear their thoughts. This study is valuable as it interviewed such a target group and collected information from diverse voices. Conclusions According to the results of the mail survey, the prevalence of apathy in the affected areas was high: 2,214 (44.2%) in total, 985 (44.5%) in men, and 1,229 (55.5%) in women, which reveals a major problem. The results of the telephone survey demonstrated that apathy can be classified into three types with different background factors: Decline, Crisis, and Carry Over. In addressing apathy, it is important to check for the co-occurrence of depression, life satisfaction, and the availability and utilization of social support. Abbreviations GEJE Great East Japan Earthquake GDS-3A Geriatric Depression Scale BMI body mass index PR prevalence ratio CI confidence interval Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology (protocol code 28/ approved on August 28, 2019). Written informed consent was obtained from all participants to publish this paper. Consent for publication Not applicable Availability of data and materials The qualitative data presented in this study are available upon request from the corresponding author. These data are not publicly available because they contain personal information. Competing interests The authors declare that they have no competing interests. Funding This research was funded by grants from Kesennuma City, a Grant-in-Aid for Research Activity Start-up (Grant number: 19K24218) from the Japan Society for the Promotion of Science, and the Ito Foundation. Authors’ Contributions Conceptualization, M.Y.; methodology, M.Y.; formal analysis, M.Y.; investigation, S.S. and Y.N.; data curation, M.Y.; writing—original draft preparation, M. Y.; writing—review and editing, Y.F., S.S., Y.N., A.K. and S.S.; visualization, M.Y.; supervision, A.K., S.S., and Y.F.; project administration, Y.S.; funding acquisition, S.S. and M.Y. All authors have read and approved the final manuscript. Acknowledgments We are grateful to the residents and staff members of Kesennuma City. References Hikichi H, Sawada Y, Tsuboya T, Aida J, Kondo K, Koyama S, Kawachi I. Residential relocation and change in social capital: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami. Sci Adv. 2017;3:e1700426. 10.1126/sciadv.1700426 . Hikichi H, Tsuboya T, Aida J, Matsuyama Y, Kondo K, Subramanian SV, Kawachi I. Social capital and cognitive decline in the aftermath of a natural disaster: a natural experiment from the 2011 Great East Japan Earthquake and Tsunami. Lancet Planet Health. 2017;1:e105–13. 10.1016/S2542-5196(17)30041-4 . Tomata Y, Suzuki Y, Kawado M, Yamada H, Murakami Y, Mieno MN, et al. Long-term impact of the 2011 Great East Japan Earthquake and tsunami on functional disability among older people: A 3-year longitudinal comparison of disability prevalence among Japanese municipalities. Soc Sci Med. 2015;147:296–9. 10.1016/j.socscimed.2015.11.016 . Li X, Buxton OM, Hikichi H, Haneuse S, Aida J, Kondo K, Kawachi I. Predictors of persistent sleep problems among older disaster survivors: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami. Sleep. 2018;41:zsy084. 10.1093/sleep/zsy084 . Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2006;77:8–11. 10.1136/jnnp.2005.069575 . Clarke DE, Ko JY, Kuhl EA, van Reekum R, Salvador R, Marin RS. Are the available apathy measures reliable and valid? A review of the psychometric evidence. J Psychosom Res. 2011;70:73–97. 10.1016/j.jpsychores.2010.01.012 . Hsu HC. Does social participation by the elderly reduce mortality and cognitive impairment? Aging Ment Health. 2007;11:699–707. 10.1080/13607860701366335 . Aida J, Kondo K, Hirai H, Subramanian SV, Murata C, Kondo N, et al. Assessing the association between all-cause mortality and multiple aspects of individual social capital among the older Japanese. BMC Public Health. 2011;11:499. 10.1186/1471-2458-11-499 . Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP, Smidt N. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39–57. 10.1016/j.arr.2015.04.006 . Creswell JW, Clark VLP. Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: Sage Publications; 2007. Yamashita M, Seino S, Nofuji Y, Sugawara Y, Osuka Y, Kitamura A, Shinkai S. The Kesennuma study in Miyagi, Japan: Study design and baseline profiles of participants. J Epidemiol. 2022;32:559–66. 10.2188/jea.JE20200599 . Bertens AS, Moonen JEF, de Waal MWM, Foster-Dingley JC, de Ruijter W, Gussekloo J, et al. Validity of the three apathy items of the Geriatric Depression Scale (GDS-3A) in measuring apathy in older persons. Int J Geriatr Psychiatry. 2017;32:421–8. 10.1002/gps.4484 . Hoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, et al. Development and testing of a five-item version of the Geriatric Depression Scale. J Am Geriatr Soc. 1999;47:873–8. 10.1111/j.1532-5415.1999.tb03848.x . Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc. 2003;51:694–8. 10.1034/j.1600-0579.2003.00216.x . Antonucci TC, Ajrouch KJ, Birditt KS. The convoy model: Explaining social relations from a multidisciplinary perspective. Gerontologist. 2014;54:82–92. 10.1093/geront/gnt118 . Saldana J. The Coding Manual for Qualitative Researchers. 2nd ed. London: Sage; 2013. Ayers E, Shapiro M, Holtzer R, Barzilai N, Milman S, Verghese J. Symptoms of apathy independently predict incident frailty and disability in community-dwelling older adults. J Clin Psychiatry. 2017;78:e529–36. 10.4088/JCP.15m10113 . Tagariello P, Girardi P, Amore M. Depression and apathy in dementia: Same syndrome or different constructs? A critical review. Arch Gerontol Geriatr. 2009;49:246–9. 10.1016/j.archger.2008.09.002 . Tay J, Morris RG, Tuladhar AM, Husain M, de Leeuw F, Markus HS. Apathy, but not depression, predicts all-cause dementia in cerebral small vessel disease. J Neurol Neurosurg Psychiatry. 2020;91:953–9. 10.1136/jnnp-2020-323092 . Mizuno A, Ly M, Aizenstein HJ. A Homeostatic model of subjective cognitive decline. Brain Sci. 2018;8:228. 10.3390/brainsci8120228 . Japan Cabinet Office. Surveys on Satisfaction and Quality of Life. 2023. https://www5.cao.go.jp/keizai2/wellbeing/manzoku/index.html . Accessed 25 Jan 2024. Carstensen LL, Isaacowitz DM, Charles ST. Taking time seriously. A theory of socioemotional selectivity. Am Psychol. 1999;54:165–81. 10.1037//0003-066x.54.3.165 . Carstensen LL. The influence of a sense of time on human development. Science. 2006;312:1913–5. 10.1126/science.1127488 . Krause N. Lifetime trauma, emotional support, and life satisfaction among older adults. Gerontologist. 2004;44:615–23. 10.1093/geront/44.5.615 . Brilman EI, Ormel J. Life events, difficulties and onset of depressive episodes in later life. Psychol Med. 2001;31:859–69. 10.1017/s0033291701004019 . Bruce ML. Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry. 2002;52:175–84. 10.1016/s0006-3223(02)01410-5 . McAdams DP, Reynolds J, Lewis M, Patten AH, Bowman PJ. When bad things turn good and good things turn bad: Sequences of redemption and contamination in life narrative and their relation to psychosocial adaptation in midlife adults and in students. Pers Soc Psychol Bull. 2001;27:474–85. 10.1177/0146167201274008 . McAdams DP, Diamond A, de St. Aubin E, Mansfield E. Stories of commitment: The psychosocial construction of generative lives. J Pers Soc Psychol. 1997;72:678–94. 10.1037/0022-3514.72.3.678 . Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Table S1.Subject profile in mail survey for men Additionalfile2.docx Table S2. Subject profile in mail survey for women Cite Share Download PDF Status: Published Journal Publication published 05 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 10 Sep, 2024 Reviews received at journal 17 Jun, 2024 Reviews received at journal 16 Jun, 2024 Reviewers agreed at journal 14 Jun, 2024 Reviewers agreed at journal 11 Jun, 2024 Reviewers invited by journal 04 Jun, 2024 Editor assigned by journal 28 May, 2024 Editor invited by journal 25 Jan, 2024 Submission checks completed at journal 25 Jan, 2024 First submitted to journal 25 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3896354","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":269689040,"identity":"bd5741b8-ea68-4c9d-9f6a-c6e2ef4f2f86","order_by":0,"name":"Mari Yamashita","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYLCCxD81PPxA+gCEe4AILR8bjslItpGihXFmA7ONwTFi3WRw/HTiZ94dbDzG97sTD35hsMlnYDyL3xqDM7mbpXnPyPCYHePdcFiGIc2ygeFcAn4tB3I3SPOwsUG0SDAcNmBgOGOAX8v5t5t/87Ax8xi3Ea3lRu42yZltzDwGbLwbDn4gRovkjbfbLD6cOcYjcSx3w2EGgzQDNkJ+4Tufu/lGQkWNPX/z2c0ff1TYGPBLEAgxBWRpoPMYGNgkzuDVwSDfgMRh/AEi+XvwaxkFo2AUjIIRBwB1w0xEro6p3wAAAABJRU5ErkJggg==","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":true,"prefix":"","firstName":"Mari","middleName":"","lastName":"Yamashita","suffix":""},{"id":269689041,"identity":"716072c9-d5ba-42f1-bec8-b5d4657676a6","order_by":1,"name":"Satoshi Seino","email":"","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Satoshi","middleName":"","lastName":"Seino","suffix":""},{"id":269689042,"identity":"bbea93fb-6c92-423a-b727-20861bc37c0a","order_by":2,"name":"Yu Nofuji","email":"","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Nofuji","suffix":""},{"id":269689043,"identity":"28f71eba-2982-4346-8536-4502681d8857","order_by":3,"name":"Yasuhiro Sugawara","email":"","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Yasuhiro","middleName":"","lastName":"Sugawara","suffix":""},{"id":269689044,"identity":"e0321f81-a29c-472b-b3b9-022974ade3c9","order_by":4,"name":"Tsuyoshi Okamura","email":"","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Tsuyoshi","middleName":"","lastName":"Okamura","suffix":""},{"id":269689045,"identity":"21a86d39-d260-4758-9066-ab76924d7b01","order_by":5,"name":"Kiyo Kawakubo","email":"","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Kiyo","middleName":"","lastName":"Kawakubo","suffix":""},{"id":269689046,"identity":"e5a28077-1e65-428f-8845-4c448455eb58","order_by":6,"name":"Shoji Shinkai","email":"","orcid":"","institution":"Kagawa Nutrition University","correspondingAuthor":false,"prefix":"","firstName":"Shoji","middleName":"","lastName":"Shinkai","suffix":""},{"id":269689047,"identity":"231e44a0-2989-4046-9e03-563346a848a7","order_by":7,"name":"Yoshinori Fujiwara","email":"","orcid":"","institution":"Tokyo Metropolitan Institute of Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Yoshinori","middleName":"","lastName":"Fujiwara","suffix":""}],"badges":[],"createdAt":"2024-01-25 07:29:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3896354/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3896354/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06165-4","type":"published","date":"2025-07-05T15:58:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":50387315,"identity":"65817569-6ca6-4f0b-8b1a-87913492b77d","added_by":"auto","created_at":"2024-01-30 17:55:34","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":293533,"visible":true,"origin":"","legend":"\u003cp\u003eInterview survey\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3896354/v1/aa2b7600710b5f5e486bb01b.jpeg"},{"id":86179214,"identity":"ff56c00d-683e-4efa-a04b-ec6207105210","added_by":"auto","created_at":"2025-07-07 16:17:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1183677,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3896354/v1/f9dc8a74-33fa-4bac-b624-473a2c9fe9ea.pdf"},{"id":50387316,"identity":"c5a477b4-8562-4d8a-9adb-eedd4f920aaa","added_by":"auto","created_at":"2024-01-30 17:55:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20225,"visible":true,"origin":"","legend":"\u003cp\u003eTable S1.Subject profile in mail survey for men\u003c/p\u003e","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-3896354/v1/a23bb2d6c5afb1297bede25c.docx"},{"id":50387314,"identity":"1eb22a81-0ebe-4c3f-b7a4-8cbeb00719da","added_by":"auto","created_at":"2024-01-30 17:55:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18171,"visible":true,"origin":"","legend":"\u003cp\u003eTable S2. Subject profile in mail survey for women\u003c/p\u003e","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-3896354/v1/aaaea7f82896d9b11feba65b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining apathy prevalence and associated factors among older adults after the Great East Japan Earthquake: A mixed-methods study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe Great East Japan Earthquake (GEJE) in 2011 and the subsequent tsunami have had long-term health consequences, including an increased prevalence of sleep disorders and mental disabilities [1\u0026ndash;4]. Addressing the psychosocial problems caused by the GEJE is an urgent issue relevant to health policies dealing with older adults in affected areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApathy, a psychosocial problem, refers to impaired motivation and is a clinically significant syndrome associated with a decline in physical, cognitive, and daily functioning [5]. However, apathy in older adults is often confused with symptoms also associated with dementia, strokes, and mood disorders such as depression [6]. The actual condition of apathy in older adults living in the affected areas is not sufficiently clear, and the factors associated with it are unknown.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, this study aimed to determine the actual condition of apathy among older adults living in the affected areas using a large-scale mail survey and identify its associated factors. Specifically, epidemiological surveys and statistical methods were used to clarify the prevalence of apathy and its associated factors. In addition, to gain a more detailed understanding of the actual condition and background factors of apathy, interviews were conducted with individuals who demonstrated apathy and limited health behaviors. Specifically, older adults with apathy who did not participate in any social activities were asked about the events preceding their apathy and how they perceived their condition, and their narratives were categorized. Social activity is one of the health behaviors associated with life expectancy and cognitive function in older adults [7\u0026ndash;9]. By clarifying the actual conditions and factors of apathy, we can consider measures to improve people\u0026rsquo;s mental health in the affected areas. For this purpose, our study was positioned as a foundational document.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a triangulation mixed-method sequential explanatory design [10]. First, in October 2019, a mail survey was conducted in Kesennuma City, one of the affected areas, involving 9754 independent older adults aged 65\u0026ndash;84 years. Responses were received from 7845 individuals (80.4% collection rate) [11]. Subsequently, 5012 questionnaires with no missing data were selected for the analysis. Those returning the mail survey who met the criteria for apathy, had no interest in participating in social activities, and gave permission to be contacted by telephone were asked to respond via an interview survey (Figure 1).\u003c/p\u003e\n\u003cp\u003e[Figure 1 near here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMail survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePrimary outcome\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApathy was assessed using three apathy items of the Geriatric Depression Scale (GDS-3A). A score of two or more was considered to demonstrate apathy [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSecondary outcome\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBasic information such as sex, age, residential status, and marital status were used, as well as socioeconomic status such as education and income; medical profiles such as subjective health and medical history; frailty; body mass index (BMI); subjective cognitive function and mobility limitations; lifestyle habits such as exercise, smoking, drinking, going out and participating in social activities, and depression [13,14]. Regarding participation in social activities, we inquired about the frequency of participation in volunteer activities, sports, hobbies, educational activities, neighborhood associations, and senior citizen clubs using the following choices: \u0026ldquo;more than once a week,\u0026rdquo; \u0026ldquo;1 to 3 times a month,\u0026rdquo; \u0026ldquo;several times a year,\u0026rdquo; and \u0026ldquo;do not participate.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTelephone survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThose who returned the mail survey and met the following criteria were asked to participate in the interview survey: 1) those who met the criteria for apathy; 2) those who did not participate in any social activities such as volunteer work, hobbies and study groups, exercise groups, neighborhood associations and community associations, senior citizen salons, and senior citizen clubs; 3) those who had no interest in social activities; and 4) those who gave their consent to be called. In response to the question, \u0026ldquo;What kind of group social activities would you like to participate in if there were any in your neighborhood?\u0026rdquo; the options were handicrafts, painting/picture writing, board games, photography, travel, getting close to nature, exercises, singing, watching films, tea parties, dinner parties, cooking and eating together, health promotion classes, and others, and those who answered that they were not interested in participating, regardless of the content of the activity. Those who answered that they did not want to participate, regardless of the content, were considered to have no interest in social activities.\u003c/p\u003e\n\u003cp\u003eA semi-structured interview survey was conducted by the first author (MY), a clinical psychologist. The questions were decided based on prior expert brainstorming, and an interview guide was prepared (Table 1). For example, regarding life history, we asked the participants \u0026ldquo;Looking back on your life, what was your happiest period?\u0026rdquo; This also primed interviewees to return and talk about the past. Similarly, we asked about their current state of apathy, followed by the question, \u0026ldquo;When did you become demotivated as you are now?\u0026rdquo; and encouraged them to actively talk about their perceptions and history of apathy. In this way, the interviewer not only tried to listen but also made appropriate facilitative remarks to encourage the story to develop. The audio data were recorded using a telephone recorder (StickPhone 8G). In principle, considering the burden on the participant, the number of telephone surveys was conducted once per participant; however, if the interview time was long, it was divided into two sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Telephone interview questions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003col\u003e\n \u003cli\u003eBasic profiles and lifestyle\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003eFamily structure, how they spend their day, life satisfaction (on a scale of 0\u0026ndash;100).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003ePerceptions of own apathy\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003eGDS-3A, \u0026ldquo;When did you become as demotivated as you are now?\u0026rdquo; \u0026ldquo;How do you feel about this?\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eSocial participation\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003eParticipation in social activities, reasons for not participating in social activities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eLife history\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026ldquo;Looking back on your life, what was your happiest period?\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003col start=5\u003e\n \u003cli\u003eSocial support\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003eConvoy model [15], \u0026ldquo;Do you have someone you can talk to if you have any problem?\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: GDS-3A: Geriatric Depression Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding quantitative data from the mail survey, the secondary outcomes were compared according to the presence or absence of apathy. The chi-square test was used for categorical variables, and the Kruskal\u0026ndash;Wallis test was used for continuous variables. In addition, the analysis was conducted using Poisson regression analysis for men and women separately, with apathy present as the objective variable and secondary outcomes as the independent variables. We calculated the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for apathy. Data were analyzed using Stata 16.0 (Stata Corp, LLC, College Station, TX, USA), and statistical significance was set at p = 0.05.\u003c/p\u003e\n\u003cp\u003eFor the qualitative data from the interviews, a thematic analysis was used to identify themes that emerged in the narratives and establish meaningful categories [16]. First, the audio data were transcribed verbatim to extract narratives that reflected their own perceptions of apathy, such as how they developed a sense of apathy and what they thought about it. The narratives of one person were interpreted as a cohesive group and assigned code names that reflected the individual\u0026rsquo;s themes. Data from the second person were interpreted in comparison with the code name assigned to the first person; if they had similar codes, they were classified into an existing code, and if different, a new code name was created. The same procedure was followed for the third and subsequent participants. In addition, codes were categorized according to their closeness and thematic names. The codes were generated by the first author alone, but the interpretation of the data, categorization process, and consistency of the thematic names was decided in consultation with the co-authors. Supervision was provided by a researcher with expertise in gerontology where appropriate, and efforts were made to avoid biased interpretation. Furthermore, to prevent divergence between themes and narratives, the analysis software MAXQDA Analytics Pro 18 was used to check the consistency of the transcripts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology. Written informed consent was obtained from all the participants.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSubject profile in mail survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe number and prevalence of apathy was 2,214 (44.2%) in total: 985 (44.5%) in men and 1,229 (55.5%) in women, with significantly more women (p\u0026lt;0.05). Table S1 shows the results for men (see Additional File 1), and Table S2 shows the results for women (see Additional File 2), comparing the basic information of the participants and related items according to the presence or absence of apathy. For both men and women, the prevalence of apathy was significantly higher in terms of age, type of residence, marital status, economic status, number of chronic diseases, BMI, mobility limitation, subjective cognitive decline, frailty, regular exercise, social participation, drinking habits, and depressive mood. For women only, in addition to the above, significant associations were also found with years of education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground characteristics of the apathy group\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the results of the Poisson regression analysis examining the factors associated with apathy by gender. In men, four factors were significantly associated with apathy: subjective cognitive decline, frailty, social participation, and depressive moods. In women, five factors were significantly associated with apathy, namely mobility limitations, subjective cognitive decline, frailty, social participation, and depressive mood. No other basic information, such as age, type of residence, or socioeconomic status, were found to be associated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItems with significant associations in the Poisson regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory (Criterion group)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepressive mood (Without)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.05**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.64\u0026ndash;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.60**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.29\u0026ndash;2.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMobility limitation (Without)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.85\u0026ndash;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.18*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.03\u0026ndash;1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjective cognitive decline (Without)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.15*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u0026ndash;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.17*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.03\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrailty (Without)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.32**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.13\u0026ndash;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.26**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.09\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial participation (Participate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot participate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.28**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.11\u0026ndash;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.27**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.12\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: IRR: Incident Rate Rations, 95% CI: 95% Confident Interval, **: \u0026lt;0.001, *:\u0026lt;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003ePerceptions of patients regarding apathy\u003c/h3\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, 229 mail survey respondents met the criteria for interviewees. They were asked to complete a telephone survey, and 36 agreed to be interviewed. Each interview lasted an average of 49.4 minutes (23\u0026ndash;160 minutes). Their narratives were categorized according to familiarity, focusing on the history and perception of apathy, and were classified into three themes: (a) Decline, (b) Crisis, and (c) Carry Over. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows a description of the themes, codes, and examples of narratives.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes regarding apathy found in narratives\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThema\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExplanation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNarrative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eA. \u003cem\u003eDecline\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eThey had a common awareness that with age, they were gradually losing their energy\u0026mdash;there exists a change in consciousness that makes us more aware of aging. For example, there was a decline in physical function, or a decline in life function, such as not being able to do things well. Lacking the will to do something and being reluctant to act on things was a theme they shared.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-1. Declining physical functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;I have trouble seeing and don't feel like doing anything. Well, I'm getting old, so I think it's normal to be like this.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-2. Decreasing self-imposed standards with age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;With age, I become less strict with myself. For example, when I try to cook for myself, I often switch to something simpler.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-3. Declining life function and self-confidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;I've lost my will. When I was in my 60s, I was always trying new things, but as I approached my 70s, I began to give up and think that nothing I did was worth it. Up until now, I've been able to make sauces for food perfectly, but I'm not confident, or rather, I'm gradually not being able to do it well.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eB. \u003cem\u003eCrisis\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThey believed their apathy was caused by major life changes. For example, they talked about devastating life events such as a serious life-threatening illness, bereavement of a spouse, divorce, sudden retirement, the shock of an earthquake, and moving house. Bereavement and retirement may or may not be directly related to the disaster.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB-1. Serious illness and lack of security\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;I can't imagine being interested in new things after being sick. I am living in the dimension of whether I will be able to live tomorrow so I don't have any plans or motivation for tomorrow. There are many people like me. I understand that there is nothing I can do about it, even if I think about it myself, so I don't feel anything.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB-2. Widowed and no competition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;After my wife passed away, I lost my sense of purpose. I'm just waiting for the time I die. I stay at home most of the time and no longer feel like going out.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB-3. The shocked by GEJE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;The earthquake was a huge shock to me. There was a period when I didn't even step out of my house. After that, things started to go wrong, and I had no energy. Somehow, I feel that no matter how hard I try, everything will be nothing in the end.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB-4. Sudden retirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;I lost my job as a fisherman in the earthquake. When I was working, I had a boat, so I used to go fishing even on my days off. My ship was washed away by the earthquake, and I no longer had the desire to buy a new one. From then on, all the things that were fun started to seem troublesome.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eC. \u003cem\u003eCarry Over\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThey had long felt low motivation even before old age. They also had strained family relationships and stressful social situations, such as debt, for long periods of time.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eC-1. Long-term isolation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;No money, no family connections. My parents passed away early, and I never thought about whether I was happy or not. I always have a feeling of giving up on life because things might not get better.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eC-2. Long-term hardship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ldquo;I've been unmotivated for longer than I can remember. I'm so busy living. To be honest, I'm in my old age and want to take it easy without working, but if I don't work, I'll starve to death tomorrow. My daughter is disabled, so she cannot work. That's why it's hard. I must go because I can't help it\u0026mdash;I just have to do it. I come home exhausted and don't have the energy to do anything. My life has been like that all along.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e near here]\u003c/p\u003e\n\u003ch3\u003eComparison of thematic features behind apathy\u003c/h3\u003e\n\u003cp\u003eTo further examine the characteristics of each theme identified in the qualitative analysis, the results of the mail and telephone surveys are tabulated by theme and presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Although statistical comparisons cannot be made owing to the presence of themes with a small number of respondents, the characteristics of each theme are described.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCross-tabulation by theme for mail and telephone surveys\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eDecline\u003c/em\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eCrisis\u003c/em\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eCarry Over\u003c/em\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMail survey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.5 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.9 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.7 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.5 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression mood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMobility limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjective cognitive decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTelephone survey\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLife satisfaction\u003c/p\u003e \u003cp\u003e(0-100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.3\u003c/p\u003e \u003cp\u003e(10\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.3\u003c/p\u003e \u003cp\u003e(50\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003cp\u003e(10\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003cp\u003e(50\u0026ndash;50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe happiest period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePast, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot isolated, and consulted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (76.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot isolated, but not consulted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIsolated, and not consulted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNote\u003c/b\u003e: Social participation is not included in this table, as not participating in social activity is a selection criterion.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the Decline type, the proportion of men and women was half, the average age was slightly older (74.9 years), and the proportion of those with subjective cognitive decline was 42.9%. The average life satisfaction score was relatively high at 78.3 points, and 33.3% of the respondents indicated \u0026ldquo;now\u0026rdquo; as the best time in their lives. Furthermore, 76.2% said that they had someone to talk to in times of trouble.\u003c/p\u003e \u003cp\u003eThe Crisis type was a relatively young group, with 85.7% being male and an average age of 69.7 years. Only one participant had subjective cognitive impairment. A high proportion (83.3%) had depressed mood, and the mean score for life satisfaction was low (58.6 points). Regarding the best period in their lives, all respondents answered \u0026ldquo;past.\u0026rdquo; Furthermore, more respondents said that they had family, friends, or other people close to them whom they could rely on but would not actually consult them, or that they had no one with whom they could consult, than those who said they had someone with whom they could and did consult. The reasons given for not consulting were that they had to solve the problem themselves.\u003c/p\u003e \u003cp\u003eThe Carry Over type consisted of one man and woman, both of whom lived with family members. Both fell into the frail category and had a life satisfaction score of 50. Both respondents stated that the best period in their lives was \u0026ldquo;never.\u0026rdquo; Furthermore, none of the respondents said that they had someone to talk to or discuss their problems with.\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e near here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eActual condition of apathy in the affected areas\u003c/h2\u003e \u003cp\u003eThe results of the mail survey revealed that approximately 44.2% of older adults living in the affected areas demonstrated apathy. Previous studies have reported a prevalence of apathy of approximately 20\u0026ndash;26% among older people living in the affected areas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and the prevalence of apathy in this study was higher by comparison. In this study, cross-tabulations showed a trend toward a higher incidence in older age groups, which was consistent with previous studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, there was no direct association between age and apathy as the effect of age became less significant after adjusting for other relevant factors.\u003c/p\u003e \u003cp\u003eRegarding factors associated with apathy after adjusting for basic information, depressive mood, subjective cognitive decline, frailty, and social participation were common for both men and women. In this study, nearly 70% of those with apathy were also depressed, suggesting that apathy and depressed mood have a high overlap. The results of the Poisson regression analysis suggested that being depressed was approximately three times more likely to be associated with apathy in men and 2.6 times more likely in women. However, around 30% demonstrated apathy only, indicating that it does not necessarily occur simultaneously with depression.\u003c/p\u003e \u003cp\u003eApathy is a common symptom in individuals with dementia and is likely to be a precursor to dementia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although this study did not measure objective cognitive decline, and the causal relationship is unknown, subjective cognitive decline was found to be associated with apathy. Subjective cognitive decline is considered the earliest identifiable symptom of cognitive impairment [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and may be associated with apathy, which is also an early symptom. In addition, although there were few direct references to forgetfulness in the telephone survey, some respondents reported declining life functioning, such as \u0026ldquo;I cannot cook well anymore, and I have lost confidence.\u0026rdquo; It has been suggested that cognitive decline and related problems in daily life may increase apathy.\u003c/p\u003e \u003cp\u003eThe association between frailty and apathy shown in this study is consistent with previous research [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, frailty is an indicator of overall health, that is, not only physical functioning, but also nutritional status and social functioning\u0026mdash;this mail survey does not tell us which functions are specifically associated with apathy. In the telephone survey, some Decline type participants reported age-related decline in physical function as a background to apathy. In contrast, Crisis and Carry Over were characterized by a decline in social function, such as not having anyone to talk to, which may differ depending on the type of apathy.\u003c/p\u003e \u003cp\u003eIn addition to the above-mentioned factors common to both sexes, only among women was there an association with mobility limitation, via a question asking about difficulties in walking and climbing stairs, difficulties that are often linked to inconvenience in daily life. It is possible that apathy is increased in women when they are forced to reduce their range of activities because of physical functional problems. Conversely, apathy may lead to inactivity in daily life and reduced mobility as the causal relationship is unclear.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eConsideration of intervention methods according to the type of apathy\u003c/h2\u003e \u003cp\u003eTo obtain a more detailed characterization of apathy, this study analyzed qualitative data from interviews with those who were apathetic, not participating, and not interested in social activities. The results were classified into three types: Decline, Crisis, and Carry Over.\u003c/p\u003e \u003cp\u003eThe Decline type was aware of aging, said they had lost energy with age, and were in an older age group. They also spoke of a decline in physical function and a loss of confidence as they progressively became less able to do everyday things. This is also consistent with the high number of people with mobility limitations and subjective cognitive decline in the mail survey. However, considering that the average daily life satisfaction of Japanese older adults was 65.3 points out of 100 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], it is noteworthy that the Decline type maintained a relatively high level of daily life satisfaction (78.3 points). Furthermore, a certain number of respondents stated that they were happiest at the time. One of the reasons for high daily life satisfaction and happiness despite apathy can be explained by the defense mechanisms of the mind. For example, the Decline type included those who said that they had become less demanding of themselves. They did the bare necessities of everyday life rather than doing new things or being sufficiently active. They were reluctant to put in effort, quicker to give up, and characterized by attributing this behavior to age, saying that they were too old to do anything about it. This may be explained by the socioemotional selectivity theory [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. According to this theory, mood adjustment is the most prioritized adaptation pattern when there is little time left in life. As a result, there is a conservative tendency to continue existing activities rather than taking on the risks associated with change, with an emphasis on maintaining existing close relationships rather than establishing new ones. In other words, apathy itself may be an adaptive strategy to age-related changes.\u003c/p\u003e \u003cp\u003eAnother possible reason could be adjustment by social support. Krause [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], in a study of older adults, reported that exposure to trauma reduces life satisfaction, but that emotional support offsets that effect. In this study, the Decline type had a high percentage of opportunities for consultation, and it is possible that the harmful effects of decreased motivation were negated by receiving support from those around them. It is also possible that they compensate for the negative effects of low motivation by receiving support from their surroundings. Considering the same, the Decline type may need to pay more attention to reduced life satisfaction, lack of social support, and loss of confidence, rather than focusing on apathy itself. Measures that confirm and encourage what is currently being done may be effective.\u003c/p\u003e \u003cp\u003eA key feature of the Crisis type is that apathy follows an experience of loss. A low level of life satisfaction suggests that apathy is accompanied by distress. Depression in older people is more likely to be triggered by loss-like events [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, McAdams calls the telling of stories about life, where life was good in the past and is now worse, the \u0026ldquo;contamination sequence\u0026rdquo; [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In a study of adults, the contamination sequence was reported to be positively correlated with depression and negatively correlated with life satisfaction [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The results are also consistent with the fact that all Crisis types in this study cited the past as the happiest period of their lives. Considering this, we believe that in Crisis types, the presence of depression should first be ascertained, and if applicable, treatment should be recommended. However, they may also find it difficult to intervene using familiar social support, given the high proportion of participants who felt that they do not actually talk to anyone close to them. Further investigation is needed to determine which support resources are more likely to be used by Crisis types with these characteristics.\u003c/p\u003e \u003cp\u003eThe Carry Over type is characterized by long-term exposure to social stress such as deprivation and isolation over the course of their lives, which they continue to carry into old age. They exhibit low levels of life satisfaction, although the small number of respondents (n\u0026thinsp;=\u0026thinsp;2) means that the figures should be interpreted with caution. It should also be noted that, although they have people living with them, they do not receive any support from them and are emotionally isolated. They are looked after less than those who live alone and may be more isolated from the rest of the family. Carry Over types require financial and welfare support to stabilize their lives. However, it is expected that they would find it difficult to connect with their social support and form lasting bonds, as they work for a living without the luxury of time and have little experience of being consulted and helped.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eA limitation of this study is that the results are from affected rural areas and may therefore differ from the incidence of apathy in urban and other areas. The results of this study cannot be directly applied to other regions, as the factors associated with apathy may differ according to regional characteristics. Although those with apathy were interviewed, the sampling would have been biased, as it targeted those who were willing to participate to the extent that they were willing to be interviewed. New categories can be identified by increasing the sample size. Despite the above limitations, few epidemiological studies have examined the prevalence of apathy in older adults living in the community on a large scale, revealing the factors associated with it, which could prove to be a source for future approaches. In addition, the participants interviewed in this study were a group of people who demonstrated apathy and did not usually participate in community activities, making it difficult for us to contact to them and hear their thoughts. This study is valuable as it interviewed such a target group and collected information from diverse voices.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAccording to the results of the mail survey, the prevalence of apathy in the affected areas was high: 2,214 (44.2%) in total, 985 (44.5%) in men, and 1,229 (55.5%) in women, which reveals a major problem. The results of the telephone survey demonstrated that apathy can be classified into three types with different background factors: Decline, Crisis, and Carry Over. In addressing apathy, it is important to check for the co-occurrence of depression, life satisfaction, and the availability and utilization of social support.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGEJE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGreat East Japan Earthquake\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGDS-3A\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeriatric Depression Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eprevalence ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology (protocol code 28/ approved on August 28, 2019). Written informed consent was obtained from all participants to publish this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative data presented in this study are available upon request from the corresponding author. These data are not publicly available because they contain personal information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by grants from Kesennuma City, a Grant-in-Aid for Research Activity Start-up (Grant number: 19K24218) from the Japan Society for the Promotion of Science, and the Ito Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, M.Y.; methodology, M.Y.; formal analysis, M.Y.; investigation, S.S. and Y.N.; data curation, M.Y.; writing\u0026mdash;original draft preparation, M. Y.; writing\u0026mdash;review and editing, Y.F., S.S., Y.N., A.K. and S.S.; visualization, M.Y.; supervision, A.K., S.S., and Y.F.; project administration, Y.S.; funding acquisition, S.S. and M.Y. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the residents and staff members of Kesennuma City.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHikichi H, Sawada Y, Tsuboya T, Aida J, Kondo K, Koyama S, Kawachi I. Residential relocation and change in social capital: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami. Sci Adv. 2017;3:e1700426. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1126/sciadv.1700426\u003c/span\u003e\u003cspan address=\"10.1126/sciadv.1700426\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHikichi H, Tsuboya T, Aida J, Matsuyama Y, Kondo K, Subramanian SV, Kawachi I. Social capital and cognitive decline in the aftermath of a natural disaster: a natural experiment from the 2011 Great East Japan Earthquake and Tsunami. Lancet Planet Health. 2017;1:e105\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2542-5196(17)30041-4\u003c/span\u003e\u003cspan address=\"10.1016/S2542-5196(17)30041-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomata Y, Suzuki Y, Kawado M, Yamada H, Murakami Y, Mieno MN, et al. Long-term impact of the 2011 Great East Japan Earthquake and tsunami on functional disability among older people: A 3-year longitudinal comparison of disability prevalence among Japanese municipalities. Soc Sci Med. 2015;147:296\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2015.11.016\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2015.11.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Buxton OM, Hikichi H, Haneuse S, Aida J, Kondo K, Kawachi I. Predictors of persistent sleep problems among older disaster survivors: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami. Sleep. 2018;41:zsy084. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/sleep/zsy084\u003c/span\u003e\u003cspan address=\"10.1093/sleep/zsy084\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarkstein SE, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer\u0026rsquo;s disease. J Neurol Neurosurg Psychiatry. 2006;77:8\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jnnp.2005.069575\u003c/span\u003e\u003cspan address=\"10.1136/jnnp.2005.069575\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke DE, Ko JY, Kuhl EA, van Reekum R, Salvador R, Marin RS. Are the available apathy measures reliable and valid? A review of the psychometric evidence. J Psychosom Res. 2011;70:73\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpsychores.2010.01.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychores.2010.01.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu HC. Does social participation by the elderly reduce mortality and cognitive impairment? Aging Ment Health. 2007;11:699\u0026ndash;707. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13607860701366335\u003c/span\u003e\u003cspan address=\"10.1080/13607860701366335\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAida J, Kondo K, Hirai H, Subramanian SV, Murata C, Kondo N, et al. Assessing the association between all-cause mortality and multiple aspects of individual social capital among the older Japanese. BMC Public Health. 2011;11:499. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2458-11-499\u003c/span\u003e\u003cspan address=\"10.1186/1471-2458-11-499\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP, Smidt N. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arr.2015.04.006\u003c/span\u003e\u003cspan address=\"10.1016/j.arr.2015.04.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Clark VLP. Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: Sage Publications; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamashita M, Seino S, Nofuji Y, Sugawara Y, Osuka Y, Kitamura A, Shinkai S. The Kesennuma study in Miyagi, Japan: Study design and baseline profiles of participants. J Epidemiol. 2022;32:559\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2188/jea.JE20200599\u003c/span\u003e\u003cspan address=\"10.2188/jea.JE20200599\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertens AS, Moonen JEF, de Waal MWM, Foster-Dingley JC, de Ruijter W, Gussekloo J, et al. Validity of the three apathy items of the Geriatric Depression Scale (GDS-3A) in measuring apathy in older persons. Int J Geriatr Psychiatry. 2017;32:421\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/gps.4484\u003c/span\u003e\u003cspan address=\"10.1002/gps.4484\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, et al. Development and testing of a five-item version of the Geriatric Depression Scale. J Am Geriatr Soc. 1999;47:873\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1532-5415.1999.tb03848.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1532-5415.1999.tb03848.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc. 2003;51:694\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1034/j.1600-0579.2003.00216.x\u003c/span\u003e\u003cspan address=\"10.1034/j.1600-0579.2003.00216.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntonucci TC, Ajrouch KJ, Birditt KS. The convoy model: Explaining social relations from a multidisciplinary perspective. Gerontologist. 2014;54:82\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/geront/gnt118\u003c/span\u003e\u003cspan address=\"10.1093/geront/gnt118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaldana J. The Coding Manual for Qualitative Researchers. 2nd ed. London: Sage; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyers E, Shapiro M, Holtzer R, Barzilai N, Milman S, Verghese J. Symptoms of apathy independently predict incident frailty and disability in community-dwelling older adults. J Clin Psychiatry. 2017;78:e529\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4088/JCP.15m10113\u003c/span\u003e\u003cspan address=\"10.4088/JCP.15m10113\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTagariello P, Girardi P, Amore M. Depression and apathy in dementia: Same syndrome or different constructs? A critical review. Arch Gerontol Geriatr. 2009;49:246\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.archger.2008.09.002\u003c/span\u003e\u003cspan address=\"10.1016/j.archger.2008.09.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTay J, Morris RG, Tuladhar AM, Husain M, de Leeuw F, Markus HS. Apathy, but not depression, predicts all-cause dementia in cerebral small vessel disease. J Neurol Neurosurg Psychiatry. 2020;91:953\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jnnp-2020-323092\u003c/span\u003e\u003cspan address=\"10.1136/jnnp-2020-323092\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMizuno A, Ly M, Aizenstein HJ. A Homeostatic model of subjective cognitive decline. Brain Sci. 2018;8:228. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/brainsci8120228\u003c/span\u003e\u003cspan address=\"10.3390/brainsci8120228\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJapan Cabinet Office. Surveys on Satisfaction and Quality of Life. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www5.cao.go.jp/keizai2/wellbeing/manzoku/index.html\u003c/span\u003e\u003cspan address=\"https://www5.cao.go.jp/keizai2/wellbeing/manzoku/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 25 Jan 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarstensen LL, Isaacowitz DM, Charles ST. Taking time seriously. A theory of socioemotional selectivity. Am Psychol. 1999;54:165\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037//0003-066x.54.3.165\u003c/span\u003e\u003cspan address=\"10.1037//0003-066x.54.3.165\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarstensen LL. The influence of a sense of time on human development. Science. 2006;312:1913\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1126/science.1127488\u003c/span\u003e\u003cspan address=\"10.1126/science.1127488\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrause N. Lifetime trauma, emotional support, and life satisfaction among older adults. Gerontologist. 2004;44:615\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/geront/44.5.615\u003c/span\u003e\u003cspan address=\"10.1093/geront/44.5.615\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrilman EI, Ormel J. Life events, difficulties and onset of depressive episodes in later life. Psychol Med. 2001;31:859\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/s0033291701004019\u003c/span\u003e\u003cspan address=\"10.1017/s0033291701004019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruce ML. Psychosocial risk factors for depressive disorders in late life. Biol Psychiatry. 2002;52:175\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0006-3223(02)01410-5\u003c/span\u003e\u003cspan address=\"10.1016/s0006-3223(02)01410-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAdams DP, Reynolds J, Lewis M, Patten AH, Bowman PJ. When bad things turn good and good things turn bad: Sequences of redemption and contamination in life narrative and their relation to psychosocial adaptation in midlife adults and in students. Pers Soc Psychol Bull. 2001;27:474\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0146167201274008\u003c/span\u003e\u003cspan address=\"10.1177/0146167201274008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAdams DP, Diamond A, de St. Aubin E, Mansfield E. Stories of commitment: The psychosocial construction of generative lives. J Pers Soc Psychol. 1997;72:678\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/0022-3514.72.3.678\u003c/span\u003e\u003cspan address=\"10.1037/0022-3514.72.3.678\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"apathy, mixed-methods study, Great East Japan Earthquake","lastPublishedDoi":"10.21203/rs.3.rs-3896354/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3896354/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to clarify the sense of apathy experienced by older adults residing in areas affected by the Great East Japan Earthquake (GEJE) in 2011 and categorized the factors associated with apathy based on their narratives.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA triangulation-mixed-method sequential explanatory design was employed. Data were collected using a mail survey among 9754 randomly selected community-dwelling independent adults, aged between 65\u0026ndash;84 years, living in Kesennuma City, one of the GEJE-affected areas, in October 2019. Of these, 7845 completed the analysis criteria, and participants who scored\u0026thinsp;\u0026ge;\u0026thinsp;2 on three apathy items of the Geriatric Depression Scale were considered to have apathy. A thematic analysis was performed on the narrative data obtained to categorize the associated factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mail survey results indicated that apathy had a prevalence of 44.2%. Using data from 30 individuals who demonstrated apathy during the interview, the thematic analysis revealed three types of apathy: (A) \u003cem\u003eDecline\u003c/em\u003e, caused by decreased physical and social functioning due to aging or illness; (B) \u003cem\u003eCrisis\u003c/em\u003e, caused by major life-changing events, such as bereavement, divorce, unexpected retirement, or disaster; and (C) \u003cem\u003eCarry Over\u003c/em\u003e, caused by strained family relationships and stressful social situations during old age.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn addressing apathy, it is important to check for the co-occurrence of depression, life satisfaction, and the availability and utilization of social support.\u003c/p\u003e","manuscriptTitle":"Examining apathy prevalence and associated factors among older adults after the Great East Japan Earthquake: A mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-30 17:55:29","doi":"10.21203/rs.3.rs-3896354/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-10T10:09:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-17T15:36:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-16T08:42:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123702233929961394167978308663612220490","date":"2024-06-14T06:37:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244891610133623959714669120663274257819","date":"2024-06-11T12:30:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-04T18:15:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-28T11:01:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-25T09:39:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-25T09:37:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-01-25T07:28:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"156e2b5a-2c5a-4c97-bb3b-2577d8310e9d","owner":[],"postedDate":"January 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:07:40+00:00","versionOfRecord":{"articleIdentity":"rs-3896354","link":"https://doi.org/10.1186/s12877-025-06165-4","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-07-05 15:58:33","publishedOnDateReadable":"July 5th, 2025"},"versionCreatedAt":"2024-01-30 17:55:29","video":"","vorDoi":"10.1186/s12877-025-06165-4","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06165-4","workflowStages":[]},"version":"v1","identity":"rs-3896354","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3896354","identity":"rs-3896354","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}