Nara Prefectural Health Research Center, Nara Medical University, Shijo-cho 840, Kashihara City, Nara, 634-8521, Japan.
BMC Geriatr. 2018 Jun 4;18(1):132. doi: 10.1186/s12877-018-0830-3.
BACKGROUND: There is insufficient evidence regarding the relationship of home environment with functional capacity among community-dwelling older people without disabilities. We conducted a population-based longitudinal cohort study and examined whether stairs in the home were associated with capability to perform instrumental activities of daily living (IADL) in community-dwelling high-functioning older adults. METHODS: The target population was individuals aged 65 years or older living in two municipalities in Nara Prefecture in Japan. At the baseline survey, residents who were independent in IADL (n = 6722) were included as survey subjects. Subjects were divided into three groups according to their home type; one-storey residences, walk-up residences, or residences with an elevator. IADL was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regression analyses stratified by gender were used to calculate the odds ratio (OR) and a 95% confidence interval (CI) for a decline in IADL, with one-storey residences as a reference. Age, studied area, marital status, working status, self-perceived economic status, body mass index, chronic diseases, smoking, drinking, eating habits, basic activities of daily living, cognitive functioning, depression, self-rated health, and social participation were used as covariates. RESULTS: During the 3-year follow-up, 11.6% of the subjects showed a decline in IADL. After adjusting for covariates, women who lived in walk-up residences had a lower risk for IADL decline (adjusted OR = 0.72, 95% CI = 0.52-0.99), while living in a home with an elevator was not associated with IADL decline (adjusted OR = 0.94, 95% CI = 0.49-1.77). In contrast, there was no association between home type and IADL decline in men (walk-up residences, adjusted OR = 0.90, 95% CI = 0.71-1.14; residences with an elevator, adjusted OR = 0.82, 95% CI = 0.39-1.72). CONCLUSIONS: The presence of stairs in the home was associated with prevention of IADL decline over a 3-year period in older women without disabilities. Although a barrier-free house is recommended for older people, our findings indicate that a home with stairs may maintain the capability to perform IADL among older adults without disabilities.
背景:对于没有残疾的社区居住老年人,家庭环境与功能能力之间的关系证据不足。我们进行了一项基于人群的纵向队列研究,研究了家中是否有楼梯与社区高功能老年人进行日常工具性活动能力(IADL)的能力之间是否存在关联。
方法:目标人群为日本奈良县两个市町村年龄在 65 岁或以上的居民。在基线调查中,将 IADL 独立的居民(n=6722)作为调查对象。根据家庭类型,将受试者分为三组:单层住宅、无电梯的多层住宅或带电梯的住宅。使用东京都老年医学研究所能力指数评估 IADL。采用多因素逻辑回归分析,按性别分层,计算 IADL 下降的比值比(OR)和 95%置信区间(CI),以单层住宅为参照。年龄、研究区域、婚姻状况、工作状况、自我感知经济状况、体重指数、慢性病、吸烟、饮酒、饮食习惯、基本日常生活活动、认知功能、抑郁、自我健康评估和社会参与作为协变量。
结果:在 3 年的随访期间,有 11.6%的受试者出现 IADL 下降。调整协变量后,居住在无电梯多层住宅的女性发生 IADL 下降的风险较低(调整后的 OR=0.72,95%CI=0.52-0.99),而居住在带电梯的住宅与 IADL 下降无关(调整后的 OR=0.94,95%CI=0.49-1.77)。相比之下,住宅类型与男性的 IADL 下降之间没有关联(无电梯多层住宅,调整后的 OR=0.90,95%CI=0.71-1.14;带电梯的住宅,调整后的 OR=0.82,95%CI=0.39-1.72)。
结论:对于没有残疾的老年女性,家中有楼梯与 3 年内 IADL 下降有关。尽管建议为老年人提供无障碍房屋,但我们的研究结果表明,有楼梯的房屋可能会维持无残疾老年人进行 IADL 的能力。
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