Decline in independence after three years and its association with dietary patterns and IADL-related factors in community-dwelling older people: an analysis by age stage and sex.

BACKGROUND: Few studies have shown age stage and sex differences in the association among dietary patterns and various health factors related to disability in older people. This study aimed to reveal the differences of characteristics, including several dietary patterns, associated with a decline in independence over 3 years in community-dwelling independent older people. Specifically, we examined data by age stage, for people between 65 and 75 years (earlier-stage) and people aged 75 years or above (later-stage), and sex. METHODS: We conducted a nationwide longitudinal study of 25 Japanese prefectures from 2013 to 2016; 2250 participants' complete data (1294 men and 956 women) were analyzed. Independence was evaluated based on instrumental activities of daily living (IADL) scores (maximum = 12). Dietary patterns were derived from a principal component analysis of the seven food groups. Baseline IADL-related factors linked to independence 3 years later were selected. Multiple logistic regression analysis for having low independence-without a full score of IADL 3 years after baseline-was conducted, adjusted for baseline IADL scores. Finally, to compare differences among age stage and sex groups, we used Multiple-Group Path Analysis. RESULTS: Participants with a full IADL score 3 years later were classified as high independence (69.6%), and those without the full score were classified as low independence (30.4%). Only the later-stage older peoples' proportion of low independence 3 years later was significantly higher than those at baseline. A high meat frequency pattern was associated with a significantly higher risk of decline in independence 3 years later in later-stage older women. The earlier-stage older people showed that 18.5 ≤ BMI < 25 was associated with a lower risk, referring to BMI < 18.5. In the later-stage, exercising three or more times a week with enjoyment and fulfillment was associated with a significantly lower risk. CONCLUSIONS: The IADL disability in older people aged 75 and over showed a rapid change. The different characteristics associated with the risk of decline in independence among age stage and sex were revealed. Targeting age stage and sex separately for community-based comprehensive supportive strategies would be necessary for a long life globally.

[Association between feelings of happiness among community-dwelling, independent, elderly individuals in an Okinawan farm village and survival three years later].

Objectives　As an indicator of subjective wellbeing, feelings of happiness assessed based on simple items have not been fully elucidated in terms of its relation to survival during old age. The purpose of this study was to examine whether the predictive validity of feelings of happiness assessed using a 4-item measure is high as an indicator of assessing survival three years later, using a variety of factors as adjustment variables among independent, elderly individuals living in a farm village in Okinawa, wherein a spirit of mutual help is prevalent among the residents.Methods　From a longitudinal study conducted in 2012, a total of 1,471 respondents (638 men, 833 women), excluding participants who needed long-term care and non-respondents of their feelings of happiness, completed a detailed questionnaire. A 4-item measure of feelings of happiness and other indicators of subjective wellbeing, including a 5-item measure of cooked food consumption, were considered as ordinal scales. From the results of the principal component (PC) analysis, we named the first PC "diet variety," of which cooked food was less consumed. The Cox proportional hazard model was used for 734 subjects' data, excluding missing values, to examine comprehensive associations among feelings of happiness, survival times, and health indicators in a multivariate model that adjusted for age, sex, and body mass index, among others. A correlation analysis between survival after three years was performed to select indicators used simultaneously in the analysis. Kaplan-Meier analysis was also conducted to examine the cumulative survival rate over three years.Results　A total of 1,387 participants (94.3%) survived during the three-year follow-up. The survival rate was significantly higher in those who indicated "very happy" items (95.9%) than in those who indicated "unhappy" items (86.4%). Meanwhile, the mortality rate was significantly higher in those who indicated "unhappy" items (13.6%) than in those who indicated "very happy" items (4.1%). Within the multivariate model, the hazard ratio (HR) for mortality three years later was significantly reduced in those with feelings of happiness (HR=0.56, 95% confidence interval [CI]: 0.32-0.99), in those who did not experiences falls and fractures (HR=0.26, 95% CI:0.11-0.62), and in those who were non-smokers (HR=0.44, 95% CI:0.25-0.77). The cumulative survival rate in those who experienced good feelings of happiness was significantly higher than in the others.Conclusion　The predictive validity of feelings of happiness assessed by a 4-item measure might be high as an indicator to assess survival three years later among independent, elderly individuals living in a farm village in Okinawa.

[Chronological evaluation of physical, psychological and social health of urban elderly dwellers over 6 years and assessment of causal inter-relationships].

OBJECTIVES: The purpose of this study is to make a chronological evaluation over 6 years of physical, psychological and social health of urban elderly dwellers. METHODS: A questionnaire survey was conducted with all urban elderly dwellers of 65 years old or more in A City in September, 2001. Answers were obtained from 13,195 people (response rate of 80.2%) in the first survey. Then 3 year and 6 year follow-up surveys of 2,375 members were performed in September 2004 and 2007. Causal relationships were analyzed using a Structural Equation Model based on the Cross-Lagged Effects Variation Model. RESULTS: According to this research, a chronological six year trend in ADL (Activities of Daily Living) was found for "physical factor" (" " means latent variable) as an observed variable, with a shifted from 91.0% to 82.9%. A trend for self-rated health with healthy as an observed variable of "psychological factor" was similarly apparent, shifting from 85.4% to 77.0%. "Social factor" conducted on the follow-up survey in 2007 was significantly affected by the "psychological factor" investigated in 2001 and "physical factor" in the follow-up survey in 2004, indirectly based on the Cross-Lagged Effects Variation Model. "Social factor" totals of 25% for men and 19% for women were explained by this model with high validity levels (NFI = 0.935, IFI = 0.950, RMSEA = 0.036). CONCLUSION: It was suggested that social health was affected by psychological health directly and physical health indirectly during six years follow-up of urban elderly dwellers. Future research is needed to encompass other generations and also to improve the external validity of the results.

[Two-dimensional classification of prefectures by life expectancy and weighted disability prevalence (WDP) with a comparison of regional characteristics].

OBJECTIVES: The objectives of the present study were to classify 47 prefectures into clusters using mortality and disability data concerning elderly people in Japan, and to identify regional characteristics of each group using community healthcare welfare indicators. METHODS: Weighted disability prevalence (WDP) was computed using determined utilities and prevalence of long-term care insurance. Prefectures were classified by hierarchical cluster analysis of life expectancy at age 65 years and age-adjusted WDP at the ages of 65-89 years, and discrimination of community healthcare welfare among clusters was examined using ANOVA and the Games-Howell pairwise comparison test. The characteristics of each group were then compared by means of differences among identified clusters. RESULTS: Four clusters were identified: a long life expectancy low disability group, a long life expectancy high disability group, a short life expectancy low disability group, and a short life expectancy high disability group. For men, health expenditures for the elderly, long-term care insurance benefits and the number of doctors were significantly higher in the long life expectancy high disability group than in the short life expectancy low disability group (in order of indicators: P<0.01, P<0.05, P<0.01). Age-adjusted mortality rates from heart disease and stroke in men were significantly lower in the long life expectancy high disability group than in the short life expectancy low disability group (in order of indicators: P<0.01, P<0.001). For women, health expenditures for the elderly and long-term care insurance benefits were significantly higher in the long life high disability group than in the short life expectancy low disability group (both indicators: P<0.05). Cancer and heart disease mortality in women were significantly lower in the long life expectancy low disability group than in the short life expectancy high disability group (in order of indicators: P<0.05, P<0.01). CONCLUSION: Classification of prefectures in groups with similar regional characteristics, comparison among regions, and identification of group characteristics are useful for objective assessment of the present state of the regions, establishing policy goals, and objectively evaluating policy effectiveness.

Calculation of prefectural disability-adjusted life expectancy (DALE) using long-term care prevalence and its socioeconomic correlates in Japan.

OBJECTIVES: The objectives of this study were: (1) to determine the disability weight, "utility", for calculation of disability-adjusted life expectancy (DALE) using the prevalence of long-term care; (2) to calculate prefectural DALE; and (3) to clarify the relation between DALE and area socioeconomic conditions in Japan. METHODS: Disability utility by care level (support and levels I-V) of long-term care insurance was determined by a survey of 236 professionals with four standard utility measures: EuroQol-5D, time trade-off, standard gamble, and visual analogue scale. DALE at age 65 (DALE65) and age-adjusted weighted disability prevalence (WDP) of 47 prefectures were calculated using the determined utilities, prevalence of long-term care, and life tables. The relationships of DALE and WDP to mortality from major causes and socioeconomic indicators were examined by correlation analysis. RESULTS: The determined utilities were: support, 0.78; level I, 0.68; level II, 0.64; level III, 0.44; level IV, 0.34; and level V, 0.21. The prefectural DALE65 ranged from 17.11 to 15.29 years for men and from 20.21 to 18.42 years for women. Strong correlations were found between DALE65 and mortality for both sexes. Male DALE65 was correlated with no socioeconomic indicators, while female DALE65 was correlated with some indicators. WDP was positively associated with indicators representing socioeconomic disadvantage, such as unemployment rate and percentage of elderly single households. CONCLUSIONS: The socioeconomic correlates of DALE and WDP suggested that favorable socioeconomic policies, in addition to a decrease in mortality from major causes, will contribute to significant extension of the independence period in the elderly. The method proposed here encourages the practical use of health expectancy in health policy, especially at local and regional levels.