Frequency of going outdoors predicts long-range functional change among ambulatory frail elders living at home
Introduction
As people age and become more frail, they often reduce their frequency of going outdoors. This likely relates to the fact that getting outside depends on a combination of physical and mental abilities, including ambulatory control, cognitive function, sense of well-being, communication with others and autonomy. Cross-sectional studies have shown that home confinement among older people is correlated with high prevalence of psychological disorders (Bruce and McNamara, 1992, Lindsay and Thompson, 1993, Bruce and Hoff, 1994, Ganguli et al., 1996, Simonsick et al., 1998, Kono and Kanagawa, 2001), physical limitation (Lindsay and Thompson, 1993, Simonsick et al., 1998, Kono and Kanagawa, 2001, Fujita et al., 2004), low social contacts (Lindsay and Thompson, 1993, Simonsick et al., 1998, Kono and Kanagawa, 2001, Fujita et al., 2004) and nutritional deficiencies (Posner et al., 1987, Roe, 1990).
In community health care settings, outdoor activities (e.g. adult day health services, day care) are recommended for older people, instead of just staying home, so as to help maintain or improve their ability to perform ADLs and to function psychosocially, even in the face of mild cognitive disorder or motor disability (Kono et al., 2002, Zank and Schacke, 2002). In Japan, community-based health services, including geriatric day care and rehabilitation, have been increasing as a national health care policy (Ministry of Health, Labour and Welfare, 2001). Although some researchers have tried to investigate the effectiveness of specific outdoor activities among frail older people, almost no data exist on the effect of simply going outdoors on quality of life among frail elders living at home.
It seems logical that getting outdoors among frail community-dwelling elders would bring beneficial stimulation to their daily life and help maintain function and psychosocial abilities. Indeed, several prospective studies already have shown that high functioning elders living at home have better survival and maintain function longer than lower functioning elders (Guralnik et al., 1995, Chandler et al., 1998, Penninx et al., 1998, Penninx et al., 1999, Cronin-Stubbs et al., 2000, Mehta et al., 2002). However, the specific effect of getting outdoors upon subsequent functional limitation or other psychosocial characteristics has not yet been documented in prospective studies.
We hypothesized that the frequency of going outdoors might be a prognostic indicator for ambulatory frail older people. In our previous report (Kono et al., 2004a), frequency of going outdoors predicted changes in functional capacity, intellectual activity and self-efficacy for health promotion and daily activities over a 9-month period among ambulatory frail elders in a rural Japanese farm community. The present study extended our investigation on relationships between frequency of going outdoors and subsequent long-range functional psychosocial changes to a full 20-month period, using the same subjects.
Section snippets
Study participants and procedure
The study was performed in Saku City, as described previously (Kono et al., 2004a). The study design was a prospective cohort analysis over 20 months. In July 2000, all 13,679 people aged 65 and older of the city were screened for needing assistance by the City Governmental Welfare Department. The present study selected 60 adjacent districts randomly from a total of 127 districts in the city. In these 60 districts, local volunteers judged 575 elders as being frail and needing some assistance to
Results
Table 1 shows the relationship between the frequency of going outdoors at baseline and living location at 20-month follow-up in 2002. More of the elderly subjects going outdoors four or more times a week at baseline were still living at home at follow-up than those in the other two groups (living at home versus not living at home; p = 0.048), while those going outdoors less than once a week were more likely to die than those who went outdoors more often at baseline, although there is not
Discussion
The present results demonstrate that the frequency of going outdoors among ambulatory frail elders living at home correlates with subsequent ADL changes over a 20-month period.
The previous study, which investigated only a 9-month period, showed that frequency of going outdoors related to changes in relatively high level function for older people, including functional capacity, intellectual activity, and self-efficacy for health promotion and daily activities (Kono et al., 2004a). In the present
Conclusion
We conclude that the frequency of going outdoors among ambulatory frail elders may be a simple multi-component indicator of older persons with functional and psychosocial problems and an important predictor of persons at risk for deterioration over long-term period. Future research should study whether frequency of going outdoors could be a useful screening question in different settings including urban areas and whether interventions to increase going outdoors could lead to improved clinical
Acknowledgements
The authors greatly acknowledge the elders and their families for participation to the study. Also the authors express their gratitude to the local volunteers and staff in the Senior Citizens’ Welfare Section in Saku City for their great support in the data collection. This research was partly supported by grants from the Japan Ministry of Health, Labour and Welfare (project leader: Shoji Shinkai) and Kimura Foundation for Nursing Education.
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