This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.

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Restrictions on going out, meeting other people, and participating in activities during the COVID-19 (coronavirus disease-2019) pandemic may have a prolonged effect on older people. This article discusses the importance of social relationships in the health of older people based on the results of the Japan Gerontological Evaluation Study (JAGES) that has conducted nationwide longitudinal studies. We selected cohort studies of JAGES, which investigated the relationships between social relationships and health, with more than 10 000 participants and published after 2010. The results showed that having contact with others, eating with others, and participating in social activities were negatively related to incident dementia, functional disability, depression, and premature death. A minimum of weekly contact with others, eating with others, and social participation by maintaining physical distancing are needed, even during the COVID-19 pandemic. For reducing the risks of transmission of coronavirus and its negative effects on health in the future, using the internet may be beneficial. The development of technological support networks for older people may be necessary.