[Predictors of functional status among independent and homebound community dwelling elderly: physical, psychological, and social parameters].

PURPOSE

The purpose of this study was to determine changes in functional status of Japanese community-dwelling elderly, and to identify physical, psychological, and social factors that predict functional change in a 1-year longitudinal study.

METHODS

A cohort of people 65 years of age and over living in two cities in Yamagata Prefecture were followed for one year. The employed degree of independent criteria developed by the Ministry of Health and Welfare had nine levels. Subjects were classified as independent (rank J) and homebound (rank A) and numbered 112 and 53, respectively. Data on demographic, physical, psychological, and social variables were collected in 1997 by mail and interview during house visits. Death and change in functional status were checked in 1998.

RESULTS

At follow-up, 1.0% of independent elders had died. Likewise, of the homebound elderly 7.7% had died. Change in functional status between the baseline and follow-up surveys were similar for both sexes and all age groups. According to nine levels criteria, rates for a good and a poor functional status of independent elderly were much the same at the baseline. Among homebound elders, 35.4% demonstrated improvement in the functional status and 14.6% deterioration. Among independent elderly, worsening of the functional status was significantly displayed, particularly with regard to hearing deficits, hospitalization within the past one year, loss of self-efficacy, fair or poor subjective health and poor functional ability. Among homebound elderly, worsening was significantly displayed in term of incontinence and poor self-efficacy.

CONCLUSIONS

When functional status at baseline was poor, deterioration was evident at follow-up survey, independent of the sex or age group. Transition in functional status can be dynamic, and improvement was more usual than worsening among homebound elderly. Our results show that increase in self-efficacy can be an effective target in programs for improvement of functional status and for prevention of functional deterioration among the independent and homebound elderly of both sexes.