Incidence of disability in housebound elderly people living in a rural community

This study aimed to explore whether being housebound is a risk factor for disabilities and whether low social communication increases incidence of disability in elderly people. A self-reported questionnaire regarding demographic characteristics was administered to 2,046 community-dwelling elderly people (aged 65 and older) in October 2000, and subjects were followed up until March 2003. All subjects were independent in activities of daily living. In this study, being housebound was defined on frequency of going out, with those who left the house once or less per week being classified as housebound. We further classified the housebound into four groups: I, going out alone is difficult but social communication occurs; II going out alone is difficult and no social communication occurs; III, going out alone is possible but not undertaken often, and some social communication occurs; and IV, going out alone is possible but seldom undertaken and no social communication occurs. In this population, overall prevalence of being housebound was 8.5%, and about half of those who were housebound fit the third classification. At the end of the follow-up period, 12.7% of subjects reported disabilities. The incidence of disability was higher in the housebound compared with the non-housebound. The incidence of disability by age was higher in housebound groups than in the non-housebound in elderly individuals aged under 85, but no significant differences were recognized in those aged over 85. In terms of housebound status, all housebound groups had higher levels of disability than the non-housebound. However, the groups without social communication (H and IV) exhibited higher incidence of disability than those with social communication (I and II). From the results obtained, we conclude that being housebound is a risk factor for disability in elderly individuals aged 65 to 85 years who are living independently, and that lower social communication also represents a risk factor for disability. This study appears to indicate that a frequency of going out of once or less a week is a valid guide for determination of housebound status.     

Predictors of houseboundedness among elderly persons living autonomously in a rural community

AIM: The housebound state is a risk factor for disability. This prospective study aimed to determine factors predictive of houseboundedness in the elderly, with an ultimate goal of preventing this condition. METHODS: A self-report questionnaire pertaining to mental, physical and social status was administered to 732 community-dwelling elderly persons (313 men, 419 women; age range, 65-85 years) in October 2000. All subjects independently performed both basic and instrumental activities of daily living, went out alone for long distances, and did not use long-term care insurance. They were followed up until March 2003. "Housebound" was defined as leaving the house once a week or less. A stepwise multiple logistic regression model, adjusted for age, was used to identity factors predictive of houseboundedness. Data were analyzed on the basis of gender. RESULTS: By the end of the follow-up period, 14.4% of men and 26.0% of women had become housebound. Stepwise multiple logistic regression analysis showed that predictive factors for men were lack of frequent contact with friends, neighbors and relatives; symptoms of lower limb pain; and self-assessed weight or muscle loss; and predictive factors for women were lack of frequent contact with friends, neighbors and relatives; lower limb pain; and self-assessed deterioration in health. Limited social contact and the presence of lower limb pain were common predictive factors for houseboundedness in both men and women. CONCLUSION: The findings from this study show that, among autonomous elderly persons, those who are socially isolated or who have physical pain are more likely to become housebound.     

Self-reported functional ability predicts three-year mobility and mortality in community-dwelling older persons

Background:  A comprehensive evaluation of the functions of community-dwelling older persons was conducted in 1988. Three years after the 1988 study commenced, the relationship between these background factors and changes during the subsequent 3 years were examined.
Methods:  The study was a comprehensive evaluation of the daily functions of community-dwelling elderly people, and encompassed age, gender, mode of living, marital status, financial status, family relationships, basic activities of daily living, visual and hearing impairment, a history of disease, self-related feeling, social role, social support, habits and physical exercise and the relationship between independence and survival for 3 years after the basic study. The subjects were 2274 community-dwelling elderly people who participated in the first survey in July 1998 and who were aged 65 years and over at that time. Unassisted questionnaire sheets were used for the first survey and changes since the first survey.
Results:  Thirty men and 60 women died during the 3 year period. Data were also gathered about the daily activity levels of 1709 persons (75.2%) with 1499 (87.7%) ranking J for independence and 210 persons (12.3%) ranking A to C for dependence. Age, gender, basic activities of daily living (BADL), history of falls, self-related happiness, participation in community events and physical-exercise habits were found to be explanatory variables for independence after three years; as were age, gender, and BADL for survival.
Conclusion:   The explanatory variables relating to independence and prognosis of life of the elderly obtained in this study will be important in future considerations of the issue of care-taking and measures to enable it.     

Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: VI. Maubin in Myanmar

Background:   The objective of the present study is to compare the findings of comprehensive geriatric assessments of community-dwelling elderly in Maubin township, Myanmar with those in Japan.
Methods:   A cross-sectional, study was undertaken of community-dwelling people aged 60 years and over who were living in downtown Maubin and two rural villages near Maubin city, and 411 people aged 65 years and over who were living in Sonobe, Kyoto, Japan. They were examined using a common comprehensive geriatric assessment tool, which included interviews regarding activities of daily living (ADL), medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale. Anthropometric, neurobehavioral and blood chemical examinations were also conducted. Using anova and Post Hoc Scheffe's F -test, findings from the three groups were compared.
Results:   Scores of basic ADL, instrumental self-maintenance, intellectual activities, social roles, QOL, Tokyo Metropolitan Institute of Gerontology Index of Competence, body mass index, total cholesterol levels, blood hemoglobin levels and HDL levels were lower in Myanmar's elderly subjects than in Japanese ones. There was no significant difference in prevalence of depression. Mean blood pressure measurements and rates of subjects with systolic pressure > 140 mmHg or diastolic pressure > 90 mmHg and prevalence of stroke were higher in downtown Maubin than in Japan. The atherogenic index was higher in Myanmar's elderly than in Japanese.
Conclusion:   In Myanmar subjects had lower ADL and QOL scores than Japanese elderly. Of particular note is the higher prevalence of anemia and subjects with history of stroke in Myanmar than in Japan. Further study is needed to detect the cause of high prevalence of stroke in Myanmar.     

Factors associated with carotid atherosclerosis in community-dwelling oldest elderly aged over 80 years

Background:   Hypertension, hyperlipidemia, impaired glucose tolerance and smoking have been known to be risk factors for atherosclerosis. Recently, it was shown that hyperhomocysteinemia is also a risk factor for cerebral vascular disease and atherosclerosis. However, it is unknown if these are also risk factors in the oldest elderly population aged 80 years or older. We carried out a cross-sectional analysis to determine the associated factors with carotid atherosclerosis in the oldest elderly living in the community.
Methods:   Subjects consisted of 136 oldest elderly aged 80 years or older living in the community. Blood pressure, orthostatic change of blood pressure, blood chemical parameters, height and bodyweight, lifestyle and medical history were examined. The thickness was measured of the total carotid artery intima-media complex (IMT) by carotid artery ultrasonography and used the maximum thickness (max IMT) for analysis.
Results:   The factors that correlated with max IMT were age and low γ-glutamyl transpeptidase in males, and serum homocysteine levels in females. The subjects were divided into two groups: those with a max IMT of less than 1.0 mm and those with that of 1.0 mm or more. Factors associated with max IMT were age and abstinence from alcohol in males, and orthostatic blood pressure change in females. Factors significantly associated with higher carotid artery IMT were aging in males and orthostatic blood pressure change in females.
Conclusion:   The factors associated with carotid artery IMT as an indicator of carotid atherosclerosis in community-dwelling oldest elderly aged 80 years or older were sex, aging, orthostatic blood pressure change and no alcohol intake. There were differences in risk factors for carotid atherosclerosis between the male and female population.     

Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: IV. Savannakhet in Laos

Background:   The objective of the present study is to compare the findings of comprehensive geriatric assessments (CGA) of community-dwelling elderly people living in Lao People's Democratic Republic (Laos) with those in Japan.
Methods:   A cross-sectional, interview- and examination-based study was undertaken. The subjects consisted of community-dwelling elderly people in Songkhon, a rural district in Laos and in Sonobe, a rural town in Kyoto, Japan. Two hundred and ninety-four people aged 60 years and over in Laos and 411 aged 65 years and over in Japan were examined using a common CGA tool. Interviews pertaining to activities of daily living (ADL), medical and social history, quality of life (QOL) and Geriatric Depression Scale as well as anthropometric, and blood chemical examinations were included in the assessment.
Results:   All scores for basic and instrumental ADL, intellectual activity and social roles, body mass index, prevalence of hypertension, mean total and HDL cholesterol levels were lower in Laos than in Japan, while prevalence of depression, impaired glucose tolerance and anemia were higher in Laos than in Japan.
Conclusion:   Differences in lifestyle and medical status were found between economically developing Laos and highly developed Japan. Almost all comprehensive geriatric functions such as ADL, QOL, mood and nutritional condition in blood chemistry were lower in the elderly in Songkhon than in Kyoto. Of particular note were the higher prevalence of diabetes mellitus and anemia and lower prevalence of hypertension in the elderly population in Songkhon district, which should be examined in future studies.     

Simple screening test for risk of falls in the elderly

Background:   The aim of this study is to construct a simple screening test for the risk of falls in community-dwelling elder persons.
Methods:   A total of 1378 community-dwelling people aged 65 years and older in five different communities in Japan were asked to answer a self rated questionnaire including 22 items covering physical, cognitive, emotional and social aspects of functioning and environmental factors. At a six-month follow-up, the outcome of fall occurrence and the number of falls was ascertained by social workers, health visitors or nurses.
Results:   Five out of 22 items were selected using a logistic regression model. Using this five-item version, a screening test was constructed, and at the best cut-off point, the sensitivity and specificity were 68% and 70%, respectively. The validity of this scale was tested on persons with cognitive dysfunction.
Conclusion:   The simplicity and the predictive validity of the screening test support the use of this test in health check ups or general outpatient facilities.     

Quantitative analysis of carotid atherosclerotic lesions and high-sensitivity C-reactive protein in community-dwelling elderly 80 years or older

Aim:   To investigate the association between the carotid atherosclerotic lesions assessed by high-resolution ultrasonography and high-sensitivity C-reactive protein (hs-CRP) in the community-dwelling elderly aged 80 years or older.
Methods:   One hundred and seventy-nine community-dwelling elderly aged 65 years or older (78 ± 6 years, 69 men and 113 women) participated in this study. High-resolution B-mode ultrasonography was performed on the common carotid arteries. Intima-media thickness (IMT) was measured using automatic measuring system and compared with standardized examinations included blood pressure, body mass index, hemoglobin-A1c, cholesterol, creatinine, uric acid, fibrinogen and hs-CRP.
Results:   Subjects were divided into two age groups: young-old aged 65–79 years (113 subjects, 74 ± 3 years) and old-old aged 80 years or older (66 subjects, 84 ± 3 years). The maximum (max) IMT was significantly increased in the old-old compared to that of the young-old (1.7 ± 1.0 vs 1.4 ± 0.6 mm; P  = 0.02). Multivariate analysis showed that hs-CRP was the strongest predictor of thickened max IMT in the young-old ( P  = 0.022). However, it was not the predictor of thickened max IMT in the old-old.
Conclusions:   Depending on age, hs-CRP may have different meanings in the atherosclerotic process. In particular, the predictive power of hs-CRP as a marker of atherosclerotic process was less significant in subjects aged 80 years or older.     

Predictors of functional status in Japanese community-dwelling older persons during a 2-year follow up

Aims:   To clarify baseline sociodemographic and health characteristics that predict subsequent functional outcome in community-dwelling Japanese older persons.
Methods:   All subjects were enrolled from the April 2001 resident registry of Nomura-cho, Seiyo-city in Ehime prefecture. Of 1392 community-dwelling persons aged 65 and older who could provide complete responses to questionnaires including functional status in the first survey, 1105 subjects were also able to provide complete answers in the second survey. Functional status was categorized according to a hierarchical scale as: completely functional; with functional limitations; and with disabilities in instrumental activities of daily living (IADL). A multivariate logistic regression model was used to estimate the ability of selected 2001 sociodemographic and health status variables to predict 2003 functional status.
Results:   Subjects consisted of 470 men (mean age ± standard deviation, 72 ± 5.9 years) and 635 women (73 ± 7.1 years). During the 2-year follow up, significant independent predictors of future functional status by multiple logistic regression analysis included: (i) age (odds ratio: 0.511, 95% confidence interval [CI]: 0.329–0.791); (ii) spouse (1.655, 1.044–2.621); (iii) activities of daily living (3.231, 2.008–5.199); (iv) baseline instrumental self-maintenance (14.62, 9.065–23.57); and (v) social role (2.176, 1.419–3.337) after controlling for baseline functional status.
Conclusion:   These results indicate that many background factors are predictive of subsequent physical function in community-dwelling older persons. Thus, early prevention and intervention regarding these background factors might be critical to promote and maintain functional status.     

What determines the life satisfaction of the elderly? Comparative study of residential care home and community in Japan

Background:   Increasing lifespan has forced elderly persons and researchers alike to look at life and aging in a new way: at adding life to years rather than years to life. With increasing lifestyle choices for the elderly, the present study was undertaken to determine and compare the factors associated with life satisfaction in elderly living in a residential care home and in the community in Japan.
Methods:   This was a cross-sectional, self-reported, questionnaire-based study. Elderly persons from the residential care home in Kyoto City ( n  = 261, mean age ± SD = 79.6 ± 6.6 years, male : female = 1 : 3.1) and from the town of Urausu, Hokkaido ( n  = 733, mean age ± SD = 74.8 ± 6.8 years, male : female = 1 : 1.3), participated in the study. This represented 95.3% and 89.5% of all eligible elderly ≥ 65 years in the home and town, respectively. Activities of daily living, higher functions, medical and social history, geriatric depression scale and quality of life were studied. Using multiple logistic regression models, factors associated with high satisfaction of life were identified.
Results:   In community-dwelling elderly, relationship with friends, as opposed to relationship with family for elderly in residential care home, were factors related to life satisfaction.
Conclusions:   This study demonstrates the relative importance of social factors versus medical and functional factors as determinants of life of elderly. We have also shown how these factors differ for elderly living in different environments. Understanding these different as well as common determinants of life satisfaction from a whole array of diverse ones allows us to make effective strategy to improve the quality of life of elderly living in different conditions.     

Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three-City Study

OBJECTIVES: To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes.
DESIGN: Four-year longitudinal study.
SETTING: The French Three-City Study.
PARTICIPANTS: Six thousand thirty community-dwelling persons aged 65 to 95.
MEASUREMENTS: Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment.
RESULTS: Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality.
CONCLUSION: Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population.     

Effect of exercise, aging and functional capacity on acute secretory immunoglobulin A response in elderly people over 75 years of age

Background:   Age-associated decline in immune function and regulation, referred to as immunosenescence, brings about an increased incidence of infectious diseases in the aged; however, there are few data on the effect of aging and exercise on mucosal immune function in elderly people. Moreover, there is no evidence on whether the change in functional capacity affects mucosal immunity in elderly people. Therefore, the aim of the present study was to examine the effects of exercise, aging and functional capacity on mucosal immune function in elderly people over 75 years of age.
Methods:   The subjects were 92 community-dwelling elderly women aged over 75 years who lived in a rural community in Miyagi Prefecture. The subjects periodically performed approximately 20 min of low intensity exercise. Saliva samples were collected before and after exercise, and saliva flow (SF), secretory immunoglobulin A (SIgA) concentration (SIgA-C) and SIgA secretion rate (SIgA-SR) were determined. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to measure functional capacity.
Results:   In comparison with before exercise, SF, SIgA-C and SIgA-SR were significantly increased after exercise in elderly subjects. In addition, when low and high value groups of resting SIgA levels were compared, acute SIgA responses were observed only in the low value group; however, there was no significant effect of aging and decline in functional capacity on exercise-induced SIgA response.
Conclusion:   These results suggest that resting SIgA levels influence the mucosal immune function response to exercise in elderly people over 75 years of age.     

Effects of low-intensity physical exercise on acute changes in resting saliva secretory IgA levels in the elderly

Background:   Although it is well known that exercise affects various immune functions, it remains to be determined whether exercise influences change in the mucosal immunity of elderly people. The objective of the present study is to examine whether low-intensity short-term exercise alters acute and long-term mucosal immune function in community-dwelling elderly people.
Methods:   The subjects of the study were 16 community-dwelling elderly people, consisting of 11 men and five women aged 60–94 (mean ± SD, 76 ± 10 years), living in Sanbongi Town (Miyagi, Japan). The subjects periodically performed about 20 min of low-intensity physical exercise (approximately 3.1 METS) at a frequency of twice a month for 3 months. Saliva samples were collected before and after exercise during the exercise class (at the start, after 1 month and after 3 months). Saliva flow, secretory immunoglobulin A (SIgA) concentration, SIgA secretion rate and total protein were determined.
Results:   The main finding was that saliva flow and SIgA secretion rates were significantly ( P  < 0.05) higher after exercise. However, the baseline value of SIgA level hardly changed at each point for the duration of the exercise class.
Conclusions:   The results suggest that low-intensity short-term exercise enhances mucosal immune function transiently in elderly people.     

Self-reported depressive state can be a predictor of engagement in work by community-dwelling elderly 2 years later

Background:   Depression is one of the most common medical disorders in elderly community-dwelling persons. The present study prospectively examined the relationship between depressive state in elderly persons and their engagement in work and/or activities during the subsequent 2 years.
Methods:   The study subjects were 603 persons who were engaged in work/activities at baseline. Their mean age ± standard deviation was 71 ± 5.1 years and 299 (49.6%) were men. The final outcome regarding engagement in work was based on whether they held a job or were engaged in activities, such as farming or gardening, every day.
Results:   At baseline, the mean SDS score was 35.5 ± 8.8 (20–63). The number of people engaged in work after 2 years decreased with increasing intensity of depressive state. Those who were engaged in work after 2 years were younger ( P  = 0.001), male ( P  = 0.047), married ( P  = 0.001), and with better financial conditions ( P  = 0.048). They were also independently able to fulfil BADL ( P  = 0.006), did not have a history of stroke ( P  = 0.040), were not regularly taking medication ( P  = 0.001) and were not depressed ( P  = 0.001). After adjustment for these covariates, depressive state was a significant independent explanatory variable, and a moderate to severe depressive state (i.e. SDS score of 48 or more) was significantly associated with less engagement in work compared with an SDS score of 39 or less (odds ratio, 2.35; 95%CI, 1.40–4.59).
Conclusion:   Depressive state is associated with an increased risk of decline in engagement in work.     

Prevalence of depressive symptoms among the elderly: A longitudinal study

Aim:   Depression is a common psychiatric problem in late life. The purpose of the present study was to assess the prevalence of depressive symptoms among community-dwelling elderly, both cross-sectionally and longitudinally.
Methods:   This study was a part of the community study in a large cohort of elderly people aged 65 and over in Nangai Village, Japan. Data on depressive symptoms from the fifth survey in 2000 were analyzed cross-sectionally and also combined with data from the first survey in 1992 to assess aging and cohort effects. Depressive symptoms were measured by the short form of Geriatric Depression Scale.
Results:   Among 1195 respondents at the fifth survey, the prevalence of depressive symptoms was 22.3%. In 457 subjects who responded at both surveys, mean depression score or prevalence of depressive symptoms tended to be higher at the fifth survey than at the first survey. The difference in prevalence between the first survey and the fifth survey among individuals of the same age groups was significant only in the oldest group (77 years and over).
Conclusion:   Among Japanese community-dwelling elderly people, aging effects on depressive symptoms were found, though marked cohort effects were not confirmed.     

Comparison of public and private care management agencies under public long-term care insurance in Japan: A cross-sectional study

Aim:   Long-Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long-term care services which had been provided by social welfare corporations or public agencies in the previous long-term care scheme. This study compared differences in care management plans for community-dwelling frail elderly people between public care management agencies and private care management agencies.
Methods:   The subjects were 309 community-dwelling frail elderly people living in a suburban city with a population of approximately 55 000 and who had been using community-based long-term care services of the LTCI for 6 months from April 2000. The characteristics of the care management agencies (public/private) were identified using a claims database. After comparing profiles of users and their care mix between those managed by public agencies and by private agencies, the effect of the characteristics of care management agencies on LTCI service use was examined.
Results:   Public care management agencies favored younger subjects ( P  = 0.003), male subjects ( P  = 0.006) and people with a higher need for care ( P  = 0.02) than private agencies. The number of service items used was significantly larger in public agencies than in their private counterparts. In multivariate regression analysis, the utilization of community-based long-term care service was significantly greater among beneficiaries managed by private agencies than those managed by public agencies ( P  = 0.02).
Conclusion:   Private care management agencies play an important role in promoting the use of care services, but their quality of care plans might be questionable.     

Six-year prospective study of physical fitness and incidence of disability among community-dwelling Japanese elderly women

Aim:   To identify physical fitness factors associated with occurrence of disability requiring long-term care and reviewing physical fitness factors to identify threshold values at which future care risk is expected to rise rapidly.
Methods:   This prospective cohort study included 74–88-year-old women who were living at home and who reported no disability in activities of daily living. The subjects completed 16 physical fitness tests, assessing walking ability, muscular strength, flexibility, agility and balance, and participated in a follow-up interview 6 years later.
Results:   Among the 60 subjects who were not disabled at baseline and who participated in the 6-year follow up, 28 subjects were certified to have a disability necessitating long-term care after 6 years. Among the 16 physical fitness tests, 13 measures showed a significant association with the necessity of care. Maximum walking time and ankle dorsiflexion range of motion (ROM) were identified as main physical fitness factors associated with later necessity of care using a multiple logistic regression model. After adjustment for age, each subject's probability of occurrence of disability necessitating care was calculated using a logistic equation. The probability rose rapidly to more than 80% when 10 m maximum walking of 74–78-year-old subjects was 10 s. For 80–88-year-old subjects, the probability rose rapidly to more than 80% when the time was at 9 s. As ankle dorsiflexion ROM narrowed, the probability rose gradually.
Conclusion:   Ability to walk rapidly is an indicative main physical fitness marker for predicting the independence of elderly women.