Impact of mental health on daily living activities of Japanese elderly
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
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