Leisure activities and instrumental activities of daily living: A 3-year cohort study from the Japan Gerontological Evaluation Study

Changes in leisure activity, all-cause mortality, and functional disability in older Japanese adults: The JAGES cohort study

BACKGROUND/OBJECTIVES

Leisure activities provide various health benefits for older adults. However, few studies have examined changes in leisure activities and health. This study aimed to determine the association among changes in leisure activities, subsequent all-cause mortality, and functional disability.

METHODS

Using a longitudinal, prospective cohort design, we analyzed data from the Japan Gerontological Evaluation Study (JAGES) in 2010 and 2013 merged with government data on death and long-term care needs by 2020. Changes in leisure activity were defined as four-category exposure based on a question about leisure activities: those with leisure activities in both 2010 and 2013, those who started leisure activities in 2013, those without leisure activities in both 2010 and 2013 (reference group), and those who stopped leisure activities in 2013. All-cause mortality and functional disability were defined as onset during the 6-year follow-up from the 2013 survey. We applied the inverse probability of censoring and treatment-weighted methods for analyses using Cox proportional hazards models, where missingness was addressed using multiple imputation.

RESULTS

The study included 38,125 participants with a mean age of 72.8 ± 5.5 years at baseline, and 46.9% were male. Among those without leisure activities between 2010 and 2013 and those who started leisure activities in 2013, mortality rates by 2020 were 28.6% and 21.1%, and functional disability rates were 24.6% and 18.1%, respectively; and in analyses with the inverse probability of censoring and treatment-weighted methods, the hazard ratio for mortality was 0.82 (95% confidence interval (CI), 0.75-0.90) and 0.89 (95% CI, 0.79-1.01) for functional disability, respectively.

CONCLUSION

Initiation of leisure activities among the older adults was associated with a lower risk of mortality and functional disability over the subsequent 6 years compared to older adults who did not report initiating any leisure activities.

Chronic disease and multimorbidity in the Chinese older adults' population and their impact on daily living ability: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Owing to an increase in life expectancy, it is common for the older adults to suffer from chronic diseases that can result in disability and a low quality of life. This study aimed to explore the influence of chronic diseases and multimorbidities on activities of daily living (ADLs) and instrumental ADLs (IADLs) in an older Chinese population.

METHODS

Based on the Chinese Longitudinal Healthy Longevity Survey (2018), 9,155 older adults aged 65 years and above were included in the study. A self-administered questionnaire was used to collect information on demographic characteristics, chronic diseases, ADLs, and IADLs. The impact of factors affecting ADL and IADL impairment in older adults was analysed using binary logistic regression.

RESULTS

In total, 66.3% participants had chronic diseases. Hypertension, heart disease, arthritis, diabetes and cerebrovascular disease were among the top chronic diseases. Of these, 33.7% participants had multimorbidities. The most common combination of the two chronic diseases was hypertension and heart disease (11.2%), whereas the most common combination of the three chronic diseases was hypertension, heart disease, and diabetes (3.18%). After categorising the older adults into four age groups, dementia, visual impairment, and hearing impairment were found to be more prevalent with increasing age. The prevalence of hypertension, heart disease, cerebrovascular disease, gastrointestinal ulcers, arthritis and chronic nephritis gradually increased with age until the age of 75 years, peaked in the 75-84 years age group, and then showed a decreasing trend with age. Multimorbidity prevalence followed a similar pattern. Regression analysis indicated that the increase in age group and the number of chronic diseases independently correlated with impairments in ADL as well as IADL. Additionally, gender, physical activity, educational background, obesity, depressive symptoms, and falls also had an impact on ADLs or IADLs.

CONCLUSION

Chronic diseases and multimorbidities are common in older adults, and it is important to note that aging, multimorbidity, obesity, and unhealthy lifestyle choices may interfere with ADLs or IADLs in older adults. Therefore, it is imperative that primary healthcare providers pay special attention to older adults and improve screening for multimorbidity and follow-up needs.

Latent transition analysis of instrumental activities of daily living in Chinese elderly: based on the 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

The instrumental activities of daily living (IADL) among the elderly have been found to be heterogeneous, with different trajectories. However, the transition of the IADL over time remains unclear. We aimed to explore the transition probabilities and the predictors of IADL among the elderly.

METHODS

Longitudinal data from the 2014 (T1) and 2018 (T2) waves of the Chinese Longitudinal Healthy Longevity Survey were extracted. A sample of 2,944 participants aged 65 years or older, with complete responses to the IADL scale, was included. Latent profile analysis (LPA) and latent transition analysis (LTA) were employed to identify latent profiles of IADL and investigate the transition probabilities between profiles from T1 to T2. The predictors of latent profiles and transition probabilities were examined using multinomial regression analysis.

RESULTS

The results of LPA at both T1 and T2 supported a 4-profile model solution. They were labeled as the "Normal function profile," "Mildly impaired profile," "Moderately impaired profile," and "Highly impaired profile". The Normal function profile and Highly impaired profile were characterized by maintaining stability rather than transitioning over time, with transition probabilities of 0.71 and 0.68, respectively, for maintaining stability. The Mildly impaired profile and Moderately impaired profile were characterized by a stronger tendency towards transition rather than stability, with transition probabilities of 0.29 and 0.45, respectively, of transitioning to the Highly impaired profile. The transition probabilities from the three impaired function profiles to the Normal function profile ranged from 0.05 to 0.19. Age, gender, place of residence, and social participation were significant predictors of profile attribution at T1 and transition probabilities over time.

CONCLUSIONS

This study employed the LTA to examine the transition probability of IADL among the Chinese elderly. By recognizing the different profiles of IADL and understanding the factors associated with transitions among the elderly, interventions can be tailored to improve their functional independence and successful reintegration into families and society.