[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.

[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.

[The relationship between ambulatory blood pressure variation and symptoms of depression and sleep disturbance in community-dwelling elderly persons with independent activities of daily living].

OBJECTIVE: To clarify the relationship between ambulatory blood pressure variation and symptoms of depression and sleep disturbance in community-dwelling elderly persons with independent activities of daily living. METHODS: The subjects were 41 volunteers in a health education class for the elderly in a rural community. We carried out: (1) an interview about symptoms of depression using the Geriatric Depression Scale (GDS), competence of daily living, subjective daily sleep complaints and past history of disease,; (2) ambulatory blood pressure measurements over 24 hours with a portable device,; (3) sleep-awake judgment by wrist actigrams,; and (4) instructions for self-records of his/her life activities. RESULTS: (1) The average value for 24 hour-mean diastolic blood pressure was significantly higher in subjects undergoing hypertension treatment. (2) No significant relationship was observed between subjective sleep disturbance and ambulatory blood pressure variation. (3) No significant relationship was observed between objective sleep disturbance assessed by wrist-actigraphy and ambulatory blood pressure variation. (4) Severe depression was related to a lower degree of night decrease in both systolic and diastolic blood pressure in subjects undergoing hypertension treatment, while it was associated with higher average values for 24 hour- and awaking-mean systolic and diastolic blood pressure in subjects not receiving such treatment. CONCLUSIONS: In community-dwelling elderly persons with independent activities of daily living, severer depression was associated with the higher mean blood pressure in subjects not taking medicine for hypertension and with a low degree of night decrease in diastolic blood pressure in those receiving hypertension treatment, while no significant relationship was observed between sleep disturbance and ambulatory blood pressure variation.