Elsevier

Preventive Medicine

Volume 46, Issue 5, May 2008, Pages 457-462
Preventive Medicine

Impact of mental health on daily living activities of Japanese elderly

https://doi.org/10.1016/j.ypmed.2007.12.007Get rights and content

Abstract

Objective

We investigated the impact of mental health on the decline in higher activities of daily living (ADL) defined in terms of social role performance (SR, the highest ADL), intellectual activity (IA), and instrumental ADL (IADL), as well as the onset of basic ADL disability.

Methods

Six hundred older adults were randomly selected from Yamanashi prefecture, Japan. An interview survey collected baseline information from 581 people (97%) in 2003. Of those, 93% were followed for 25 months by mail. Cox's proportional hazard model was used.

Results

Among people aged 75+ years, those with severe depressive symptoms had a relative risk (95% confidence intervals) of 3.22 (1.35–7.71), 3.11 (1.38–6.98), and 2.41 (1.07–5.40) for subsequent decline in SR, IA, and IADL, respectively, compared to those without depressive symptoms. The excess risk of IADL decline among people aged 65–74 years was also statistically significant. Social inactivity partly explained the excess risk.

Conclusions

Severe depressive symptoms in older adults may accelerate the progression of higher ADL decline. The adverse effect of depressive symptoms is more pronounced in senior elderly. By screening depressive symptoms and higher ADL, and promoting social activities of people at high risk, their risk for basic ADL disability could be reduced.

Introduction

Many developed countries now have highly aged population structures. Japan is no exception. In general, risk of disability in activities of daily living (ADL) increases with advancing age. Increasing number of older people with disability results in a higher healthcare cost and individuals' poor quality of life (WHO, 2002). To maintain independent living in a community, physical, mental, and social functional capacities are required (WHO, 2001). According to Lawton (1972), older adults' functional capacities consist of seven stages from the most basic, life maintenance, to the most advanced, social role performance (SR). Another study suggests that these functional capacities deteriorated from the highest to the lowest (Fujiwara et al., 2003a). That is, SR is most likely to be lost with advancing age, followed by intellectual activity (IA), and instrumental ADL (IADL). The deterioration of these higher ADL predicts more basic ADL (BADL) disability such as feeding, toileting, or transferring (Shinkai et al., 2003).

Many papers have reported adverse effects of poor mental health on BADL (Dunlop et al., 2005, Penninx et al., 1999, Lenze et al., 2005, Patrick et al., 2004, Cronin-Stubbs et al., 2000, Tas et al., 2006, Kivela and Pahkala, 2001, Jiang et al., 2004). We have, however, found no studies that have investigated the impact of mental health on higher ADL decline, which is critical in understanding the pathway linking mental health to disability.

Using the longitudinal data from the Yamanashi Healthy-Active Life Expectancy Cohort (Y-HALE) study, we investigated the impact of mental health on higher ADL decline as well as on the onset of BADL disability. We particularly focused on social activities as factors which could modify the effect of mental health on ADL decline because recent evidence has suggested that social activities are closely associated with mental health (Kawachi and Berkman, 2001) and they potentially protect disability (Mendes de Leon et al., 1999, Mendes de Leon et al., 2001).

Section snippets

Study population

The baseline data were collected from a two-stage probability sample of 1800 non-institutionalized older adults (65 or older) in Yamanashi prefecture in 2002. The response rate was 93.3% (1680 subjects). Persons who did not qualified for public long-term care insurance benefits were selected. The municipality determined an applicant's eligibility for long-term care insurance benefits on the basis of one's physical or cognitive function using a standardized procedure including physician's

Results

At baseline, young–old subjects had higher income, higher educational attainment, higher social activities, better TMIG-IC score, and fewer regular outpatient visits compared to old–old subjects. Gender distribution, smoking habits, alcohol consumption, exercise habits, and depressive symptoms did not differ between both age groups. The baseline TMIG-IC scores of our subjects were similar to those obtained in another study in Japan. Mean (standard deviation) of the score in young–old and

Discussion

We found that severe depressive symptoms significantly increased the risk for higher ADL decline. Depressive symptoms most strongly affected social role function, followed by intellectual activity and instrumental ADL. These associations were particularly shown among the old–old subjects. Social inactivity partly explained these excess risks.

Among the old–old subjects, poor mental health was most strongly related to subsequent SR decline, followed by IA and IADL. This result is supported by a

Conclusions

The present study provides important evidence that severely depressive older persons have two- to three-fold higher risk for higher ADL decline compared to nondepressive persons and this excess risk was partly explained by social inactivity. Given these results, it may be important to assess mental health status regularly in order to prevent higher ADL decline and BADL disability of the elderly. The promotion of social activities could reduce their risk for further functional decline.

Acknowledgments

NK had roles in conducting follow-up studies, analysis, and writing this paper. MK presented the general idea of this study and carried out preliminary analysis. KS and ZY contributed to the acquisition of the subjects and the interpretation of the results. We are grateful for the assistance provided by Yasuhisa Takeda, Junko Minai, Yuko Kawakubo, Richard Wamai, Onil Bhattacharyya, and Yasunori Sato. This study was funded by the 2003 Grant-in-aid for Special Supports for Community Services

References (34)

  • JiangJ. et al.

    Exploring the influence of depressive symptoms on physical disability: a cohort study of elderly in Beijing, China

    Qual. Life Res.

    (2004)
  • KawachiI. et al.

    Social ties and mental health

    J. Urban Health

    (2001)
  • KivelaS.L. et al.

    Depressive disorder as a predictor of physical disability in old age

    J. Am. Geriatr. Soc.

    (2001)
  • KondoN. et al.

    Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses

    J. Epidemiol.

    (2005)
  • KoyanoW. et al.

    Measurement of competence in the elderly living at home: development of an index of competence

    Nippon Koshu Eisei Zasshi

    (1987)
  • LawtonM.P.

    Assessing the competence of older people

  • LenzeE.J. et al.

    The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the cardiovascular health study

    J. Am. Geriatr. Soc.

    (2005)
  • Cited by (54)

    • Community social capital and inequality in depressive symptoms among older Japanese adults: A multilevel study

      2018, Health and Place
      Citation Excerpt :

      Specifically, in Japan, Wada demonstrated that in the years 2000/2001, 33.5% of older people in four rural towns had depressive symptoms, defined as scoring more than 5 points on the Geriatric Depression Scale (GDS-15) (Wada et al., 2004). Depression can cause other critical health issues including suicide, frailty, functional disability, and mortality (Waern et al., 2003; Kondo et al., 2008; Wada et al., 2004). Therefore, depression is a key target of the public health actions targeted to older adults in Japan and worldwide (World Health Organization, 2010; Ministry of Health Labour and Welfare, 2012).

    View all citing articles on Scopus
    View full text