{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:14:20Z","timestamp":1788200060161,"version":"build-2803163510"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although sense of coherence (SOC) is a core concept to promote healthy aging, evidence of whether SOC improves loss of independence (LOI) or death is lacking. We aimed to investigate the association between SOC and LOI or death in older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled independent older adults aged 65 years or over from a population-based cohort. SOC was assessed using a three-item SOC scale at baseline. The primary outcome was a composite of LOI (defined by Japanese long-term care insurance certification) or death. We investigated the association of SOC with LOI or death using the Cox proportional hazards model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 5.8 years, 128 out of 1,661 (7.7%) participants had LOI or death. Lower SOC (per 1 standard deviation [SD] decrease) was associated with a higher risk of LOI or death (adjusted hazard ratio 1.25, 95% confidence interval [CI] 1.07 to 1.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Lower SOC (per 1 SD decrease) was associated with a higher risk of death (adjusted hazard ratio 1.24, 95% CI 1.03 to 1.50,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022) as well.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Older adults with a lower SOC were more likely to experience LOI or death. Enhancing SOC could promote healthy aging in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355726","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:24:58Z","timestamp":1788197098000},"page":"e0355726","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between sense of coherence and loss of independence or death in older adults: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3356-2005","authenticated-orcid":true,"given":"Sho","family":"Matsushita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshie","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1104-2612","authenticated-orcid":true,"given":"Yosuke","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"pone.0355726.ref001","unstructured":"World Health Organization. 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Conceptual framework and item selection","volume":"30","author":"Jr Ware JE","year":"1992","journal-title":"Med Care"},{"key":"pone.0355726.ref036","volume-title":"Kenkouseiseiryoku SOC to jinsei, shakai-zenkoku daihyou sampletyousa to bunseki","author":"Y Yamazaki","year":"2017"},{"issue":"7","key":"pone.0355726.ref037","first-page":"669","article-title":"Advanced statistics: missing data in clinical research-part 2: multiple imputation","volume":"14","author":"CD Newgard","year":"2007","journal-title":"Academic Emergency Medicine"},{"issue":"2","key":"pone.0355726.ref038","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/00031305.2016.1154108","article-title":"The ASA\u2019s statement on p-values: context, process, and purpose","volume":"70","author":"RL Wasserstein","year":"2016","journal-title":"Am Stat"},{"issue":"4","key":"pone.0355726.ref039","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/BF00301325","article-title":"Sense of coherence and outcome of low-back surgery: 5-year follow-up of 80 patients","volume":"5","author":"N Santavirta","year":"1996","journal-title":"Eur Spine J"},{"issue":"4","key":"pone.0355726.ref040","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jpsychores.2014.12.010","article-title":"Sense of coherence and 22-year all-cause mortality in adult men","volume":"78","author":"G Geulayov","year":"2015","journal-title":"J Psychosom Res"},{"issue":"4","key":"pone.0355726.ref041","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/PSY.0b013e31828c3fa4","article-title":"Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality","volume":"75","author":"A Haukkala","year":"2013","journal-title":"Psychosom Med"},{"issue":"6","key":"pone.0355726.ref042","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1093\/eurpub\/ckw086","article-title":"Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association?","volume":"26","author":"C Nilsen","year":"2016","journal-title":"Eur J Public Health"},{"issue":"6","key":"pone.0355726.ref043","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/PSY.0000000000000812","article-title":"Sense of Coherence and Mortality: A Systematic Review and Meta-Analysis","volume":"82","author":"I Piiroinen","year":"2020","journal-title":"Psychosom Med"},{"key":"pone.0355726.ref044","doi-asserted-by":"crossref","first-page":"100494","DOI":"10.1016\/j.alcr.2022.100494","article-title":"Long-term changes in sense of coherence and mortality among middle-aged men: A population -based follow-up study","volume":"53","author":"I Piiroinen","year":"2022","journal-title":"Adv Life Course Res"},{"issue":"5","key":"pone.0355726.ref045","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1136\/jech-2013-203085","article-title":"A weak sense of coherence is associated with a higher mortality risk","volume":"68","author":"S Super","year":"2014","journal-title":"J Epidemiol Community Health"},{"issue":"2","key":"pone.0355726.ref046","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jpsychores.2006.02.014","article-title":"Resilience, misfortune, and mortality: evidence that sense of coherence is a marker of social stress adaptive capacity","volume":"61","author":"PG Surtees","year":"2006","journal-title":"J Psychosom Res"},{"key":"pone.0355726.ref047","unstructured":"Ministry of Health, Labour and Welfare. 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