Saito Tami, Murata Chiyoe, Aida Jun, Kondo Katsunori
Department of Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan.
Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
BMC Geriatr. 2017 Aug 16;17(1):183. doi: 10.1186/s12877-017-0580-7.
Living arrangements of older adults have changed worldwide with increasing solitary and non-spouse households, which could affect social care systems. However, the relationship between these households and disability onset has remained unclear. We examined the relationship between living arrangements and the onset of basic activities of daily living disability in older adults, with a focus on gender differences and cohabitation status of those without a spouse.
Data from 6600 men and 6868 women aged 65 years or older without disability were obtained from the Aichi Gerontological Evaluation Study Project in Japan. Onset of disability was followed for 9.4 years. Disability was assessed based on Long-term Care Insurance System registration. A hierarchical Cox proportional hazards model was conducted to examine the risk of living alone and living only with non-spousal cohabitants compared to those living with spouses.
Men living only with non-spousal cohabitants and those living alone were significantly more likely to develop disability after controlling for health and other covariates (hazard ratio = 1.38 and 1.45, respectively), while a significant difference was found only for women living alone (hazard ratio = 1.19). The risk of living with non-spousal cohabitants was marginally stronger in men, indicated by the interaction effect model (p = .08). A series of hierarchical analyses showed that social support exchange explained 24.4% and 15.8% of the excess risk of disability onset in men living alone and those living only with non-spousal cohabitants, respectively. A subsequent analysis also showed that support provision by older adults more greatly explained such excess risk than receiving support from others.
Older men without spouses were more likely to develop disability onset regardless of cohabitants. Health professionals should consider programs that enhance social support exchange, particularly support provision by older adults who are at risk of disability.
随着独居和非配偶家庭在全球范围内的增加，老年人的生活安排发生了变化，这可能会影响社会护理系统。然而，这些家庭与残疾发生之间的关系仍不明确。我们研究了老年人的生活安排与日常生活活动残疾发生之间的关系，重点关注性别差异以及无配偶者的同居状况。
从日本爱知县老年学评估研究项目中获取了6600名65岁及以上无残疾男性和6868名无残疾女性的数据。对残疾发生情况进行了9.4年的跟踪。根据长期护理保险系统登记评估残疾情况。采用分层Cox比例风险模型，研究与配偶同住相比，独居和仅与非配偶同居者发生残疾的风险。
在控制了健康状况和其他协变量后，仅与非配偶同居者和独居的男性发生残疾的可能性显著更高（风险比分别为1.38和1.45），而仅独居女性存在显著差异（风险比 = 1.19）。交互效应模型表明，男性与非配偶同居的风险略强（p = 0.08）。一系列分层分析表明，社会支持交换分别解释了独居男性和仅与非配偶同居男性残疾发生额外风险的24.4%和15.8%。随后的分析还表明，老年人提供支持比接受他人支持更能解释这种额外风险。
无论同居情况如何，无配偶的老年男性发生残疾的可能性更高。卫生专业人员应考虑开展增强社会支持交换的项目，特别是为有残疾风险的老年人提供支持的项目。
