Abstract
BackgroundLittle is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care. We investigated the cross-sectional association between medical expenses (ME) and intellectual activity (IA) in community-dwelling older Japanese.MethodsSelf-administered questionnaires were mailed to all residents born between 1945 and 1949 and covered by A City’s medical insurance system (n = 19,354). Independent variables including health behaviors, oral health, social capital, neighborhood environment, and physical and mental functioning were included in the questionnaires. Medical fee receipts were used to evaluate ME for fiscal 2014, and respondents were classified into no, low, medium, and high ME groups. Higher-level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is comprised of three subscales: instrumental activities of daily living, IA, and social role. Poisson regression models were used to examine the association of ME with IA, with the low ME group as reference.ResultsQuestionnaires were returned by 12,747 individuals (response rate 65.9%). The no ME group had the lowest response rate, the worst lifestyle behaviors, and the lowest social capital, but no problems with neighborhood environment. Higher-level functional capacity, especially IA, was reduced in both the high ME and no ME groups. After adjustments for age, gender, health insurance, accessibility to public facilities in their residential area, family size, body mass index, and physical and mental functioning, the prevalence ratio (PR) for impaired IA lost its significance in the high ME group (PR 0.97, 95% confidence interval 0.90–1.05), but remained significant in the no ME group (1.19, 1.08–1.31). After additional adjustments for health behaviors (i.e., health checks, smoking, fitness, and dietary variety), the PR of the no ME group was attenuated towards the null (1.08, 0.98–1.20).ConclusionsCommunity-dwelling elderly who did not seek medical treatment were indifferent to health surveys and health-promoting behaviors, and undesirable health behaviors were a possible determinant of their impaired IA. Further longitudinal research is needed to confirm the causal associations.
Highlights
Little is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care
In October 2015, questionnaires were distributed to all people who satisfied the following three conditions: (1) they lived in A City on March 31, 2015, (2) they were born between 1945 and 1949, and (3) they were covered by the National Insurance, medical insurance for later-stage elderly, or livelihood subsidies, and the coverage period by one of the above was 1 year or longer as of March 31, 2015
Because our findings have a potential for confounding by educational background, future studies should consider education when evaluating the association between medical expenses (ME) and intellectual activity (IA) among community-dwelling elderly. This cross-sectional study found that communitydwelling elderly with no ME had a low response rate, unhealthy lifestyle habits, and a low level of social capital
Summary
Little is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care. We investigated the cross-sectional association between medical expenses (ME) and intellectual activity (IA) in community-dwelling older Japanese. Elderly people tend to have many more ailments than younger people, so medical expenses (ME) naturally become much higher in aging populations [2]. In a super-aging society like Japan, the issue of suppressing health-care expenditures is urgent. Some municipalities in Japan have tested schemes such as giving a reward to those who do not receive health insurance treatment in an effort to suppress ME [3]. It is necessary to investigate the lifestyle habits, health conditions, and higher-level functional capacities of the community-dwelling elderly who do not undergo medical treatment
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