Ogawa Y, Iwasaki K, Yasumura S
Department of Public Health, Yamagata University School of Medicine.
Nihon Koshu Eisei Zasshi. 1993 Sep;40(9):859-71.
The purpose of the present study is to clarify the relationship of physical, sociological and psychological factors to health status, the decline in activities of daily living (ADL) and death, in community elderly residents, by analysis of participation or non-participation in a comprehensive health survey. Subjects were 737 elderly residents (306 males, 431 females) aged 70-75 years living at home in Fujishimamachi, a rural town of Yamagata prefecture. A baseline comprehensive health survey including door-to-door survey for non-respondents to the comprehensive survey, was performed in 1986, and repeated at follow-up five years later. The results obtained are as follows: 1) In both sexes, survival rate was highest in the respondents to the comprehensive health survey and lowest in non-respondents to either surveys. Causes of death, place of death, the bedridden period prior to death and ADL before bedridden status were different among those three groups. 2) Factors predisposing to ADL decline (all subjects had competent normal ADL at the baseline survey) were low self-rated health, low score of the Index of Competence developed by Tokyo Metropolitan Institute of Gerontology (the TMIG Index of Competence), inactivity in daily life especially in household affairs and social activities. The predicting factors of death were almost similar to those of ADL decline mentioned above. The relationship of the factors to health status was stronger in those who had to be surveyed door-to-door compared to respondents to the comprehensive health survey, and in women than in men. 3) Blood pressure, ECG findings, retinal findings, hand grip, memory as measured by the Benton Visual Retention Test showed no relationship to either ADL decline or mortality. 4) The present study shows that subjective health and functional capacity are useful to predict the outcome of community elderly residents. Further, life styles and health behavior have a significant effect on outcome prediction.
本研究的目的是，通过分析社区老年居民参与或未参与一项综合健康调查的情况，阐明身体、社会学和心理因素与健康状况、日常生活活动能力（ADL）下降及死亡之间的关系。研究对象为山形县一个乡村小镇富士岛町70 - 75岁的737名居家老年居民（男性306名，女性431名）。1986年进行了一次基线综合健康调查，包括对综合调查无应答者进行上门调查，并在五年后的随访中重复进行。得到的结果如下：1）在两性中，综合健康调查的应答者生存率最高，两项调查的无应答者生存率最低。这三组人群的死亡原因、死亡地点、死亡前卧床期以及卧床前的ADL情况均有所不同。2）导致ADL下降的因素（所有受试者在基线调查时ADL功能正常）包括自我健康评分低、东京都老人综合研究所制定的能力指数得分低（TMIG能力指数）、日常生活尤其是家务和社会活动不活跃。死亡的预测因素与上述ADL下降的因素几乎相似。与综合健康调查的应答者相比，上门调查对象中这些因素与健康状况的关系更强，且女性比男性更强。3）血压、心电图检查结果、视网膜检查结果、握力以及通过本顿视觉保持测验测量的记忆力与ADL下降或死亡率均无关系。4）本研究表明，主观健康和功能能力有助于预测社区老年居民的结局。此外，生活方式和健康行为对结局预测有显著影响。
