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Title: [Classification of Japanese elderly in an urban area at risk of becoming homebound: knowledge for improving prevention strategies].
Author: Shibui Y, Murayama H, Kawashima T, Kano N, Toratani A, Tachibana R, Shibuta K, Fukuda Y, Murashima S.
Journal: Nihon Koshu Eisei Zasshi; 2011 Nov; 58(11):935-47. PubMed ID: 22352066.
Abstract:
OBJECTIVES: This study aimed to assess the living situation and health of elderly people in an urban area of Japan at risk of becoming homebound, so as to tailor measures to prevent or delay this occurring. We identified the prevalence rate of people currently homebound and those at risk, classifying using predictors reported in previous studies. An assessment of physical and cognitive factors affecting each classified group was included. METHODS: The survey targeted 149,991 people aged 65 or older living in Setagaya Ward in Tokyo. Mail-in questionnaires included items to assess respondents' demographic characteristics, physical and mental health conditions, quality of life, activities of daily living, and social lifestyles. We operationally defined people who go out (leave their home) only two or three times a week as the "at-risk" group, and "homebound" was defined as going out only once a week or less. Then we determined the prevalence rates of the homebound and at-risk group. We sub-classified the at-risk group by conducting a cluster analysis using predictors of homebound status reported in previous studies. Then we identified each group's characteristics by comparing mental health and cognitive condition between the groups. RESULTS: Questionnaire responses from those who did not fill out the survey themselves or who failed to fully answer questions on homebound predictors used in the cluster analysis were excluded. Also disregarded were responses from hospital inpatients or residents of elderly care facilities. The final number of respondents included in the analysis was 90,605. The prevalence rate of elderly who were at risk of becoming homebound was found to be 13.0% (n=11,282). Cluster analysis identified five clusters based on instrumental ability of daily living, mental health and cognitive condition: very good condition (46.4%), depressive (23.5%), low cognitive function and depressive (19.6%), low Instrumental Activities of Daily Living (IADL) (6.5%) and very poor condition (3.8%). The very good condition group fared favorably in nearly all aspects assessed in the questionnaire. The depressive group and the low cognitive function and depressive group strongly indicated anxieties about falling or about their future life and included people who went out less frequently compared with the previous year. The low IADL group and the very poor condition group were comparatively old and included a high percentage of people registered as requiring long-term care. CONCLUSION: Based on the particular characteristics of the identified groups, we propose primary strategies to help elderly people who are at risk of becoming homebound: 1) Very good condition group: Identify reasons why their frequency of outings is just two or three times a week, even though they seem to be healthy, and provide assistance with maintaining their current health condition considering those reasons. 2) Depressive group: Prevent physical decline by providing consultations addressing their anxieties about falling. 3) Low cognitive function and depressive group: Intervene in the early stages to address negative cognitive states such as loneliness. 4) Low IADL group: Intervene to help maintain their remaining abilities including cognitive function. 5) Very poor condition group: Ensure maintenance of services or support currently being provided, and have community health care providers and staff monitor health status changes.

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