The differential effects of type and frequency of social participation on IADL declines of older people

Abstract

BackgroundAlthough social participation (SP) is valid in active aging, it is vague which types and the frequency of SP are effective in maintaining instrumental activities of daily living (IADL). We conducted a community-based prospective cohort study and investigated the association of the types and frequency for SP with IADL decline in community-dwelling older adults.MethodsThe target population were all individuals aged ≥65 living in a commuter town in Nara, Japan. A total of 6,013 participants with independent IADL at baseline were analyzed. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Six SP types were assessed: volunteer groups, sports groups, hobby clubs, senior citizens’ clubs, neighborhood community associations, and cultural clubs. The frequency of SP was categorized into frequent (i.e., weekly or more), moderate (i.e., monthly or yearly), and non-participation. Using multiple logistic regression models, the odds ratio (OR) and a 95% confidence interval (CI) for IADL decline were calculated. Covariates included age, marital status, education, subjective economic status, work status, body mass index, chronic medical conditions (i.e., hypertension, diabetes mellitus, heart disease, and cerebrovascular disease), lifestyle factors (i.e., alcohol, smoking, and exercise), self-rated health, depression, and cognitive functioning. To examine gender differences, stratified analyses by gender were performed.ResultsDuring the 33-month follow-up, 16.4% of men and 8.7% of women exhibited IADL decline. After adjustment for all covariates, compared to those who never participated, women with moderate participation had significantly lower odds of IADL decline in volunteer groups (OR = 0.53, 95% CI = 0.31–0.88), hobby clubs (OR = 0.55, 95% CI = 0.38–0.79), neighborhood community associations (OR = 0.58, 95% CI = 0.42–0.81), and cultural clubs (OR = 0.51, 95% CI = 0.31–0.82), and women with frequent participation had lower odds of IADL decline in hobby clubs (OR = 0.63, 95% CI = 0.43–0.93). In contrast, among men, the significant association between SP and less risk of IADL decline was limited to moderate participation in neighborhood community associations (OR = 0.79, 95% CI = 0.63–0.99), and there were no differences between frequent participation and non-participation in all types of SP. Regarding volunteer groups, compared to women with frequent participation, women with moderate participation had a significantly lower risk of IADL decline (OR = 0.37, 95% CI = 0.18–0.77). The results of additional stratified analyses by self-rated health, depression, and cognitive functioning showed that the associations of the type and frequency of SP with IADL decline varied according to physical and mental functioning.ConclusionsSeveral types of SP have a favorable effect on IADL through moderate participation rather than frequent participation, and women with moderate participation in volunteer groups have a more beneficial effect on IADL than women with frequent participation. When ...

Social Participation and Functional Decline: A Comparative Study of Rural and Urban Older People, Using Japan Gerontological Evaluation Study Longitudinal Data

“…The analysis of the number of organizations revealed the HRs of the number of types of organizations progressively decreased as the number of participating organizations. This supports previous studies, including those measuring other health outcomes [10,13,[16][17][18]. In this study, HRs were lower when participated in two or more types of organizations in rural areas than in urban areas.…”

“…According to this result, a good public health policy would include local government provision of regular opportunities for social participation in sports and hobbies in both rural and urban areas. Participation in sports and hobby groups has also been reported to prevent other poor health outcomes [16,18,19]. Previous studies have shown that older people in rural areas were unhealthier than older people in urban areas [20,24,29,30], but in this study, there was no difference in the incidence of functional disability between older people in rural and urban areas.…”

“…This study has two strengths. First, this is the first study to target older people in many municipalities, including rural and urban areas, in contrast to previous studies that only focused on the number and type of organization in which older people participated [10,13,[16][17][18]. Second, the data used in this study was collected over a long period (about six years) and excluded respondents receiving long-term care within two years, thereby removing the possibility of reverse causality (i.e., the possibility that people who had a high risk of functional decline did not participate socially).…”

“…In many longitudinal studies, social participation has been reported as effective for health outcomes such as functional disability [9][10][11][12][13], cognitive disability [14][15][16], instrumental activities of daily living decline [17][18][19], and basic activities of daily living decline [20]. Among them, some studies focused on the number and types of organizations in which older people participated [10,13,[16][17][18]. These studies suggested that older people who participate in more organizations are healthier than those who do not participate, and that the relationships between social participation and health varied according to the types of organization they participate in.…”

“…However, these studies [10,13,[16][17][18] do not consider two issues. First, these studies do not consider "work" as a kind of social participation.…”