Japan has one of the longest life expectancies worldwide. The number of people aged ≥65 is >36 million, accounting for 29.1% of the population in 2023 (Statistics Bureau, 2023). In Japan, the number of older adults with certificates of long-term care needs under the long-term care insurance (LTCI) system has continuously increased since its introduction in 2000, reaching >6.5 million people in 2019 (Iwagami and Tamiya, 2019). Increasing care needs lead to social issues, such as family caregivers' physical, psychological, social, and economic impairments, a burden on young carers, and a shortage of manpower in nursing homes (Okamoto and Komamura, 2022; Vrettos et al., 2023). It is important to prevent the development of disabilities to manage the increase in care needs and extend healthy life expectancy.

Many studies have shown that physical activity (PA) reduces the risk of physical, cognitive, and mental decline and the development of disabilities (Fielding et al., 2017; Rodrigues et al., 2022). Engagement in PA may be more effective for reducing the risk of disability when accompanied by cognitive activities (CA) (Kurita et al., 2020). Previous studies have reported that cognitive leisure activities are associated with a reduced future risk of cognitive decline and dementia, which in turn prevents disability development (Verghese et al., 2003; Yates et al., 2016). In addition, engaging in social activities (SA) has been found to reduce the risk of developing dementia, depression, and disability (Fratiglioni et al., 2004; Katayama et al., 2022; Katayama et al., 2021). Accordingly, PA, CA, and SA are recognized as crucial healthy lifestyle behaviors and targets for interventions for the primary prevention of disability development (Kulmala et al., 2019; Shimada et al., 2022). However, inducing behavior change or adopting healthy behavior is challenging (Guthold et al., 2018).

Psychological factors play an important role in engaging in healthy behaviors (Kiviniemi et al., 2007; Millstein et al., 2020). Positive psychological constructs, such as emotions and cognition, help initiate or maintain PA (Millstein et al., 2020). In addition, positive attitudes toward life and health are consistently associated with lower rates of multimorbidity and disability (Calderón-Larrañaga et al., 2019). Previously, we found that community-dwelling older adults who have higher perceived value (PV) to adopt new healthy behaviors, such as PA, CA, and SA, which denotes that they think positively about adopting those behaviors, are associated with more actual engagement in those activities (Nishijima et al., 2024). However, the association between positive evaluation of value and incident disability remains unclear.

This study aimed to clarify the relationship between PV and incident disability in community-dwelling older adults. We hypothesized that a higher PV is associated with a lower incidence of disability and modulates the relationship between PA, CA, SA, and incident disability. As perceptions and thinking patterns can change through experience and education(Alvarez et al., 2009; López-López et al., 2019), value-enhancing initiatives may be additional targets for interventions to prevent disability development.