Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study

Shuko Takahashi,Yuki Yonekura,Kozo Tanno,Kazuyoshi Itai,Megumi Tsubota-Utsugi,Akira Okayama,Toru Kuribayashi,Toshiyuki Onoda,Shinichi Omama,Yasuhiro Ishibashi,Ryohei Sasaki,Makoto Koshiyama,Eri Takusari,Kiyomi Sakata,Masaki Ohsawa,Fumitaka Tanaka

doi:10.1186/s12877-020-01743-0

Abstract

BackgroundAlthough previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study.MethodsA total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex.ResultsThe number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes).ConclusionSelf-rated health, therefore, might be a useful predictor of functional disability in elderly people.

Highlights

Previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers
During follow-up (112,490 person-years), 3377 participants were authorized as new recipients of long-term care insurance (LTCI) for functional disability (1245 men and 2132 women, 3.3% per year)
SRH was worse in participants who were non-employed or retired, single, and never drinker and who had a low frequency of regular exercise, short sleep duration (≤ 6 h), long sleep duration (≥ 9 h), hypertension, and diabetes mellitus

Summary

Introduction

Previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study. Japan has achieved the highest longevity ratings in the world (81 years of age for men and 87 years of age for women) [10], and the proportion of people aged 65 years or older is estimated to be 35.6 million (28.1% of the population) [11]. There is an ongoing issue about sustaining senior health using social security in order to balance the financial burdens of pension and health care expenditure [13]

Objectives

Methods

Results

Discussion

Conclusion