Older Men Living with Spouse and Older Women Living with Spouse and Children Have Lower Frailty Prevalence: The Korean Frailty and Aging Cohort Study (KFACS)

Effect modification of social participation in the relationship between living arrangements and frailty among older adults in Japan: Differences based on gender

BACKGROUND

Frailty is a common global concern that is closely related to aging, especially in Japan. This study clarifies the relationship between living arrangements and frailty among older Japanese adults and the effect of social participation based on gender, with the aim of developing social preventive and intervention strategies.

METHODS

Panel data were obtained from the 2016 and 2019 Japan Gerontological Evaluation Studies. A total of 23,630 older adults, aged 65 years and older, were included. Frailty was assessed using the Kihon Checklist. Multivariable logistic regression models were used to examine the association between living arrangements and frailty and the effect of social participation based on gender.

RESULTS

A total of 1,589 (6.72 %) participants reported the new onset of frailty. No independent association was found between living arrangements and frailty, regardless of gender, after controlling for covariates. Diverse forms of social participation decreased the risk for frailty among men. For women, living with a spouse was associated with a higher risk for frailty, compared with women who lived alone; however, women who lived with children and participated in three or more social activities had a lowered risk for frailty.

CONCLUSIONS

For men, social participation played a more important role in the risk for frailty than did living arrangement. However, social participation moderated the association between living arrangements and frailty in women. Therefore, the promotion of social participation can be included in health prevention and intervention programs to decrease the risk for frailty.

The experience of living alone as an older woman in the UK during the Covid pandemic: an interpretative phenomenological analysis

BACKGROUND AND OBJECTIVES

More people are living alone across the life course: in later life this can have implications for practical and psychosocial support. The Covid pandemic emphasised the importance of this when the UK government restricted movement outside of households to limit the spread of disease. This had important ramifications regarding social contact and practical support. The objectives of this study were to explore the experience of older women living alone during this time, with a focus on health and wellbeing.

RESEARCH DESIGN AND METHODS

This study used an Interpretative Phenomenological approach. Semi-structured interviews were undertaken with seven women (aged 65 +), living alone in the UK. Interviews were carried out between May and October 2020. Interpretative Phenomenological Analysis was used to analyse the transcripts.

RESULTS

Findings show that life course events shaped how living alone was experienced in later life. Convergences and divergences in lived experience were identified. Three superordinate themes emerged from the Interpretative Phenomenological Analysis: Productivity, Ownership, and Interconnectedness.

DISCUSSION AND IMPLICATIONS

Findings highlight the importance of life course events in shaping the experience of later life. They also provide a better understanding of the lived experience of living alone as an older woman, increasing knowledge of this group and how living alone can affect health and wellbeing. Implications for research and practice are discussed, such as the importance of recognising the specific support needs for this group in later life, and the need for further knowledge about groups whose needs are not met by standard practice.

ARRANJO FAMILIAR, APOIO SOCIAL E FRAGILIDADE EM IDOSOS DA COMUNIDADE: ESTUDO LONGITUDINAL COM MÉTODOS MISTOS

RESUMO Objetivo analisar, ao longo do tempo, a constituição dos arranjos familiares de idosos e a relação destes com o apoio social, a fragilidade, qualidade de vida e cognição. Também, verificar, na perspectiva destes sujeitos, tensões existentes no contexto familiar. Método estudo longitudinal, com métodos mistos e triangulação concomitante. Aplicaram-se entrevista sociodemográfica, Escala de Fragilidade de Edmonton, WHOQOL-BREF e OLD, The Montreal Cognitive Assessment, Genograma e Ecomapa. Os dados quantitativos utilizaram teste de comparação de Wilcoxon e Mann Whitney; e os de abordagem qualitativa, a análise de conteúdo de Bardin, com o materialismo dialético como referencial teórico. Resultados dos 84 idosos no período do estudo (2012/2016-2019), a maioria tinha mais de 70 anos e era do sexo feminino (83,3%). A fragilidade e cognição não apresentaram relação estatística significativa com o tipo de arranjo familiar. Idosos que moravam sozinhos apresentaram pior qualidade de vida nos domínios físico (p=0,044) e psicológico (p=0,031). Idosos que moravam com netos apresentaram piora no domínio relação social (p=0,047) e melhora no domínio morte e morrer (p<0,001). Encontraram-se três categorias e nove subcategorias, as quais evidenciaram a importância das relações de interdependência e apoio na família. A integração dos dados demonstrou que o tamanho do arranjo familiar e os tipos de membros não determinam a existência de apoio, mas os vínculos formados com a família e comunidade. Conclusão a fragilidade e cognição não apresentaram diferença estatística com o tipo de arranjo familiar, porém essa relação foi encontrada em alguns domínios da qualidade de vida.

FAMILY ARRANGEMENT, SOCIAL SUPPORT AND FRAILTY AMONG COMMUNITY-DWELLING OLDER ADULTS: A MIXED METHODS LONGITUDINAL STUDY

ABSTRACT Objective to analyze, over time, the constitution of the older adults' family arrangements and their relationship with social support, frailty, quality of life and cognition; in addition to verifying existing tensions in the family context from the perspective of these subjects. Method a longitudinal study, using mixed methods and concomitant triangulation. A sociodemographic interview, the Edmonton Frailty Scale, WHOQOL-BREF and OLD, The Montreal Cognitive Assessment, Genogram and Ecomap were applied. The quantitative data used the Wilcoxon and Mann Whitney comparison test; and those with a qualitative approach were treated according to Bardin's content analysis, with dialectical materialism as a theoretical framework. Results most of the 84 aged people in the study period (2012/2016-2019) were over 70 years old and female (83.3%). Frailty and cognition did not present a statistically significant relationship with the type of family arrangement. Aged people who lived alone had a worse quality of life in the physical (p=0.044) and psychological (p=0.031) domains. Older adults who lived with grandchildren showed worsening in the social relationship domain (p=0.047) and improvement in the death and dying domain (p<0.001). Three categories and nine subcategories were found, which highlighted the importance of interdependent and supportive relationships in the family. Data integration showed that the family size arrangement and the types of its members do not determine the existence of support, but the bonds formed with family and community. Conclusion frailty and cognition presented no statistical difference with the type of family arrangement, although this relationship was found in some quality of life domains.

Longitudinal impact of oral health on geriatric syndromes and clinical outcomes in community-dwelling older adults

Background

Oral health is essential for daily living and plays a pivotal role in overall health conditions and well-being. This study evaluated the impact of self-reported oral health on geriatric conditions, institutionalization, and mortality.

Methods

This study analyzed the population of the Aging Study of Pyeongchang Rural Area that had undergone geriatric assessments between 2016 and 2017. The oral health status of the participants was determined using three items from the General Oral Health Assessment Index, and the participants were classified into three groups according to the total sum of the scores as good (3), fair (4–7), or poor (8–15). The outcomes were the incidence of geriatric syndromes at 2 years and the composite outcome of mortality and institutionalization.

Results

Among the 1189 participants, 44.1 % were women, and the mean age of the study population was 75.0 years. Good, fair, and poor oral health were observed in 597 (50.2 %), 406 (34.1 %), and 186 (15.6 %) individuals, respectively. Worsening oral health status was associated with the incidences of various geriatric syndromes at follow-up, and these associations were attenuated after adjusting for baseline demographic and geriatric parameters. Similarly, the significant association between baseline oral health status and the incidence of the composite outcome was attenuated after adjusting for demographic and geriatric parameters.

Conclusions

Oral health affected the geriatric health conditions in this prospective, longitudinal cohort of community-dwelling older adults. The correlations and interactions of oral health status with other functional parameters may deserve consideration as a geriatric domain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02416-2.

Place of Death and Density of Homecare Resources: A Nationwide Study in Japan

Background

Although more than half of the population of Japan wants to spend their last days at home, approximately only 10% are able to do so. This study examined the associations between death at home and healthcare facility density by municipality based on the analysis of nationwide observed data in Japan.

Methods

We used data on deaths at home and healthcare resources in municipalities across Japan for the fiscal years 2014 and 2017. The proportions of deaths at home by municipality were used as the dependent variable, while healthcare resources (e.g., hospital density) divided by the population of older people in each municipality and municipality-level income were used as independent variables. We applied a fixed-effects regression analysis to examine the association of healthcare resources and municipality-level income with death at home.

Results

Clinics providing home medical care and facilities providing visiting nursing services were positively associated with death at home, with coefficients (95% confidence intervals) of 2.14 (1.12 to 3.15) and 2.19 (0.99 to 3.39), respectively. Stratified analysis showed that these associations were observed in higher income-level municipalities but not in lower income-level municipalities.

Conclusion

Municipalities with a higher density of home care services had higher rates of death at home, whereas municipalities with a higher density of hospitals had lower rates. We recommend the development of policy that allows hospitals to be converted into home care providers so that more people can spend time in peace at home at the end of their lives.

Correlation between the number of laparoscopy-qualified gynecologists and the proportion of laparoscopic surgeries for benign gynecological diseases in Japan: An ecological study

AIM

We aimed to evaluate regional disparities in the proportion of the three main laparoscopic surgeries for benign gynecological diseases among 47 prefectures in Japan and their correlation with the number of laparoscopy-qualified gynecologists per population.

METHODS

In this retrospective ecological study, we collected the data of patients from 47 prefectures in 2017 using "The National Database of Health Insurance Claims and Specific Health Checkups of Japan" Open Data from the Ministry of Health, Labor and Welfare in Japan. The primary outcome of the study was the proportion of laparoscopic surgeries conducted for benign gynecologic diseases (hysterectomy, myomectomy and surgery for the benign ovarian diseases). The main exposure was the number of laparoscopy-qualified gynecologists per 100 000 females.

RESULTS

The average proportion of laparoscopic hysterectomies, myomectomies and surgeries for the benign ovarian disease were 38% (standard deviation (SD) 16, range 12-74), 48% (SD 18, range 9-81) and 60% (SD 11, range 36-79), respectively. Multiple regression analysis showed a significant correlation between the number of laparoscopy-qualified gynecologists per 100 000 females and the proportion of the three main laparoscopic surgeries.

CONCLUSION

There are obvious regional disparities in the proportion of the three main laparoscopic procedures for benign gynecological diseases among 47 prefectures. The number of laparoscopy-qualified gynecologists correlated significantly with these regional disparities. The academic society should monitor these regional disparities and make an effort to reduce these regional disparities by increasing laparoscopy-qualified gynecologists in areas where the widespread use of laparoscopic techniques is lagging.