Hikichi Hiroyuki, Kondo Naoki, Kondo Katsunori, Aida Jun, Takeda Tokunori, Kawachi Ichiro
Center for Preventive Medical Science, Chiba University, Chiba, Japan Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
School of Public Health, The University of Tokyo, Tokyo, Japan.
J Epidemiol Community Health. 2015 Sep;69(9):905-10. doi: 10.1136/jech-2014-205345. Epub 2015 Apr 17.
The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias.
The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called 'community salons', providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument.
In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74).
A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.
由于残留混杂因素和选择偏倚,促进社交互动以改善老年人健康的效果尚未完全确立。
日本爱知县竹丰町政府制定了一项以居民为中心的社区干预计划,称为“社区沙龙”,为当地老年居民提供社交互动机会。为评估该计划的影响,我们对竹丰町所有老年居民进行了问卷调查。我们在2006年7月(该计划实施前)进行了基线调查,并评估了2012年3月期间功能残疾的发病情况。我们分析了2421名老年人的数据。除了标准的Cox比例风险回归分析外,我们还使用倾向得分匹配(PSM)的Cox回归分析和工具变量(IV)分析,以参与者家周围350米范围内的社区沙龙数量作为工具变量。
在首次举办沙龙后的5年里,与未参与者相比,沙龙参与者的功能残疾发生率降低了6.3%。即使对性别、年龄、等效收入、教育程度、更高水平的日常生活活动能力和抑郁情况进行调整后,Cox调整后的残疾风险比(HR)为0.49(95%置信区间为0.33至0.72)。使用PSM(HR为0.52,95%置信区间为0.33至0.83)和IV-Cox分析(HR为0.50,95%置信区间为0.34至0.74)也观察到了类似结果。
一项侧重于增加老年人社交互动的社区健康促进计划可能对预防残疾的发生有效。