Takaharu Goto, an assistant professor in the Department of Prosthodontics and Oral Rehabilitation at Tokushima University in Japan, discusses the impact of biopsychosocial factors on an individual's experience of ikigai in episode 89 of the Ikigai Podcast.
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A Deep Dive into the Mima-SONGS Study
Takaharu co-authored a paper titled ‘Biopsychosocial Consideration of Ikigai in Older Adults in Japan through a Cross-Sectional Study.’ The study, known as the Mima-SONGS study, was conducted in Koyadaira, Tokushima Prefecture, Japan, and examines the relationship between healthy life expectancy and various factors among older adults living in hilly and mountainous regions.
A study on Japan's hilly and mountainous regions
Nick: I recently stumbled upon your paper ‘Biopsychosocial Consideration of Ikigai in Older Adults in Japan through a Cross-Sectional Study’, which was published in early June this year. So congratulations, I know papers take a lot of research and time.
Takaharu: Thank you very much.
Nick: Thank you for writing it. And this paper seemed to be, or was it a collaborative effort with six other research authors. So how did this paper come about?
Takaharu: This paper presents the findings from studying Koyadaira, Mima City, Tokushima Prefecture, Japan. It is commonly called the Mima-SONGS study. This study examined the relationship between the healthy life expectancy and oral, cognitive, and the physical functions; social factors such as participation in community activities, and nutritional intake among older adults in hilly and mountainous regions in Japan.
Japan had the highest aging rate in the world, its policies to extend the healthy life expectancy and measures for the elderly are attracting attention. Most studies on the elderly in Japan have been in urban and suburban areas. However, there is a growing interest in hilly and mountainous regions, which accounts for 70% of Japan's land area, as well as marginalized communities, as research field.
The Mima-SONGS study is a field study conducted in the hilly and mountainous regions. May I explain a little about the study?
Nick: Yeah, sure. So the study’s around hilly, so hills, and mountainous areas. So this is, I guess, a unique perspective on the study.
Takaharu: Yes, the Koyadaira is in the east of Tokushima prefecture on Shikoku Island in southwestern Japan. The area is 95% surrounded by mountains, and with a population of 582 and an aging rate of 63%. It is considered to have a high probability of disappearing in the near future. The Mima-SONGS study is supervised by Dr. Shinji Fujiwara, Director of the Kiyahira Clinic.
I was introduced to Dr. Fujiwara by Emeritus Professor Tetsuo Ichikawa and Professor Yasuhiko Shirayama of Tokushima University. I have been involved in the study. Do you know the Koyadaira area?
Nick: No, but I think this is a common problem. Many areas, their population is shrinking, and they could sort of disappear.
Takaharu: I stayed there during my research. It's a wonderful area, rich in nature. If you're interested in coming, please contact me, I will show you around.
Nick: Okay. Well, let's do that. I'm going back to Japan this year, so I'd love to do that. Thank you for the invitation.
Understanding Biopsychosocial: The Intersection of Mind, Body, and Society
Takaharu and his colleagues found the biopsychosocial model effective for assessing ikigai. Biopsychosocial is an approach that systematically considers the interplay of biological, psychological, and social factors in understanding health and well-being.
Biopsychosocial: a holistic approach
Nick: So let's touch on the title of your paper, Biopsychosocial Consideration of Ikigai in Older Adults in Japan through a Cross-Sectional Study. I think it might be helpful to define biopsychosocial.
Takaharu: This approach systematically considers bio biological, psychological, and social factors and their complex interactions in understanding health, illness, and healthcare delivery.
In recent years, the medical field has used this biopsychosocial model, instead of traditional reductionist mystics biomedical model, to assess the relationship between a patient's biological, psychological, and social factors and the degree to which these factors influence a person's symptoms.
We have found this approach to be very useful in assessing ikigai as it relates to a variety of factors.
Nick: Yeah, so that's interesting. It's a very holistic approach. And I guess, ikigai is this holistic approach to life, or what makes life worth living.
Takaharu: Exactly, yes.
Nick: I think in medicine, you tend to isolate people's health in certain areas. I guess, with time we've realized that we have to look at the whole health—the biology and the psychology and the social factors of someone's life. So I think this makes sense. And so, in the context of this study, how did you define ikigai?
Takaharu: In this study, we define that ikigai can be explained by physical, psychological, or social components. We don't know which is the primary one, but we believe that there is a fundamental state of fulfillment in which the components are fulfilled; and then the elemental fulfillment and the sense of missions are built on top of that, and ikigai is obtained.
Nick: Yeah, this is really interesting for me, after studying ikigai for five years now, I knew social, the social aspect of ikigai is very important. And then obviously, the psychological. I would almost frame ikigai as positive psychology, like Japan's version of positive psychology.
And I guess, to have a fulfilling life, we need to be active and healthy, so we need this physical aspect of health. So it's another interesting framework to understand ikigai—our physical health, our psychological health, and our social health.
Sarcopenia and Its Impact on Life Functions
The Mima-SONGS Study, conducted by Takaharu and his colleagues, is a cross-sectional research project involving 105 outpatients aged 65 and over. This study focuses on ikigai and also examines sarcopenia, a condition characterized by the loss of muscle mass and strength with age. The research assesses the relationship between sarcopenia, frailty, nutritional status, and overall life functions.
A unique study focused on Koyadaira area
Nick: So with your study, you did a cross-sectional study on sarcopenia, frailty and healthy life expectancy. Can you share the details of the cross-sectional study. and maybe we should define sarcopenia.
Takaharu: Yes, as I mentioned earlier, this study is called the Mima-SONGS study. This cross-sectional study included 105 outpatients, aged 65 and over, who regularly visit the Mima Municipal Koyadaira Clinic, the medical institution only in this area.
In this paper, we present the results of our research focusing on ikigai. In addition to this ikigai research, for example, sarcopenia, which means musculoskeletal disease in which mass muscle mass, strength, and performance significantly compromised with age was assessed in this study.
In addition to this sarcopenia status, frailty, oral function, food intake, nutritional status, and higher life functions were assessed, and have presented the relationship between them. One of our co-researchers, Mio Kitamura of Tokushima University, this year, she published an interesting study on the relationship between field work as a daily life task and the physical and cognitive function among the elderly living in Koyadaira area.
This field work as a daily life task means working in small-scale cultivated land. In this Koyadaira area, many elder people actually felt that working in this small-scale cultivated land was their ikigai. The Mima-SONGS study was conducted with a baseline survey in 2018. And the second survey five years later in 2023, last year.
So the data from the longitudinal study is currently being comprised under the supervision of the principal investigator Dr. Fujiwara.
Nick: I understand. So quite a lot of people, and quite a lot of research has been conducted for this study. And again, it's quite unique, it's isolated to this hilly, mountainous area of Japan. And it included fieldwork, so that means people going out, and talking to people, making observations.
Takaharu: This 105 patients, are almost all the people living in Koyadaira, so it's a very unique study supervised by Dr. Fujiwara.
Nick: So when we're saying old, would that be 60 and above? 70 and above? Or 80 and above? What age group?
Takaharu: The oldest age now is over 90. So the above average age is 79.02, is the average age.
Nick: Okay, so 70s and above? Wow.
Measuring One’s Level of Ikigai
In their study, Takaharu and his colleagues evaluated the patients' level of ikigai based on their responses to the question, 'Do you have any pleasure or ikigai?' Participants rated their ikigai on a scale from 0 to 5, where 0 indicated no ikigai and 5 indicated a high level of ikigai.
Simplified method for assessing ikigai
Nick: Well, this is interesting, because it's all done to assess people's ikigai, what makes their life worth living. So how did you measure the participants’ level of ikigai?
Takaharu: In the study, ikigai was assessed through the patient's response to the questions: do you have any pleasure or ikigai? on the basis of the previous report. As an operational definitions, this subjective score of 0 indicated having no ikigai, and 5 indicated having higher ikigai.
The participants were asked to rate self-rated ikigai on the scale of 0 to 5, with higher scores representing higher ikigai.
Nick: Okay, so quite a simplistic approach. The question, do you have any pleasure or ikigai? And 0 to 5. So I think this is similar to the Likert scale or maybe not. And obviously, five would be highest level, and zero would mean no ikigai at all.
Takaharu: To brand this study design, simplifying the question is very important, because people need to answer many questions. So simplifying the question is very important.
Nick: Understand. Okay, so with that, what did the study reveal?
Takaharu: This study reveals that affective psychological status, such as depression, has a large impact on ikigai, along with physical, cognitive, psychological, and social conditions. Thus, it is appropriate to consider that good affective psychological status is a fundamental condition for having ikigai.
Nick: Yeah, this is interesting, I guess, as we get older, our physical abilities become restricted, perhaps, because of that, we socialize less, and we spend maybe more time alone. And so then we have, I guess, more time to reflect on our life, and it impacts our psychological health.
So maybe if we're have good health, we can reminisce and think about good memories, and still have a positive outlook on life. But I imagine, loneliness also comes into this, especially in hilly and mountainous areas where it's harder to access and visit friends or family.
Ikigai in Action: The Diverse Potentials for a Fulfilling Life
Today, Japanese companies are adopting health management strategies to safeguard employees' well-being and ensure long-term viability. Takaharu and his colleagues, in their study on the elderly, emphasize ikigai's role in work engagement and life purpose. Economically, prioritizing ikigai can lower insurance costs and societal expenses, highlighting its substantial potential.
Ikigai has considerable potentials
Nick: So with all these in mind, based on the study, what can contribute to higher levels of ikigai?
Takaharu: Our research shows that, as I said earlier, it is appropriate to consider that good affective psychological status is a fundamental condition for having higher levels of ikigai. We believe that by adjusting one’s affective psychological status, one's physical and social status can be improved, and that the elements of fulfillment and a sense of mission can be built upon this to contribute to the enhancement of ikigai.
Now, Japanese companies are currently employing variety of strategies to address the issue of health management, which can be defined that the protection of employee’s health with a view to ensuring the long-term viability of the company. In Mima-SONGS study, we investigate the ikigai of the elderly.
Our findings suggested that it is important for the energetics working with generation to have a perspective on ikigai or purpose in life or work engagement. From an economic standpoint, focusing on ikigai can lead us financial burden on insurance and ensure the individual thereby contribute to the reduction of national social costs, security costs, we believe that ikigai is a significant concept with considerable potentials.
Nick: Alright, so there's two things here. Really, your study revealed it starts with psychological health, one must have psychological health, and then from that, this leads to also maintaining physical and social health.
And then for the country, this is a positive thing; if someone has a sense of ikigai in their own age, it would suggest that they're proactive in community, they can look after themselves. And they're not a burden on the government, and they're not, I guess, eating up resources where they need care, or they need medical attention, or perhaps even psychological assistance.
And with Japan's aging population, the more healthy the elderly people out in the community, maybe they're contributing to the community. That's obviously a very positive thing, rather than, I guess, elderly people being very dependent on the government and funding. This is also something forecasting, as more and more Japanese age, there'll be more demand on government resources.
And added to that, is the decreasing population with more and more reduction in the work force. It's going to be very hard to tax a reduced workforce to fund the health of the elderly.
Takaharu: Exactly, yes. I think the results of this study, ikigai has very significant potentials, like reducing the cost of government insurances. Ikigai has the potential.
For the full podcast conversation go to: Biopsychosocial Influences on Ikigai