Skip to main content
NCBI home page
Preventive Medicine Reports logoLink to Preventive Medicine Reports
. 2022 Nov 2;30:102037. doi: 10.1016/j.pmedr.2022.102037

Protective and high-risk social activities associated with homebound status among older adults in rural Japan

Mayumi Mizutani a,⁎, Ritsuko Nishide a, Susumu Tanimura a, Hiroyo Hatashita b
PMCID: PMC9747622  PMID: 36531108

Abstract

Becoming homebound can be devastating for older adults in rural communities. This study aimed to identify protective or high-risk social activities associated with homebound status among the rural young old (ages 65–74) and the oldest old (ages ≥ 75). We used data from a survey of older adults in a rural community of Japan in 2014. Questions covered sociodemographic characteristics, homebound status (i.e., going out less than once a week), physical and psychological status, and social activities. Using survey data, we conducted logistic regression analysis to identify protective and high-risk social activities associated with homebound status. Of the 1,564 participants, 51.0 % were the oldest old, and the mean age was 75.2 (±7.0) years. The prevalence of homebound status was 10.5 % total: 5.2 % among the young old and 15.7 % among the oldest old and highest among the female oldest old (19.4 %). The main protective social activity for the young and the oldest old was visiting friends’ houses (adjusted odds ratio [AOR] 5.38, 95 % confidence interval [CI] 1.64–17.64 and AOR 3.49, 95 % CI 1.07–11.42, respectively). For the young old, specific high-risk social activities were advising family and friends (AOR 0.07, 95 % CI 0.01–0.62) and activities to support older adults (AOR 0.17, 95 % CI 0.03–0.84). For the oldest old, a protective social activity was participating in long-term care prevention programs (AOR 28.94, 95 % CI 1.90–441.63). To prevent rural older adults from becoming homebound, support should be provided according to protective and high-risk social activities for age groups, with particular attention to safe socialization amid the threat of COVID-19.

Keywords: Rural health, Japan, Aged, Homebound, Protective factors, Risk factors

1. Introduction

Longitudinal studies of older adults have shown that being homebound is associated with increased risk of mortality, lower intellectual activity, reduced self-efficacy in daily activities and health promotion, and increased functional dependence (Hamazaki et al., 2016, Katsumata et al., 2007, Kono et al., 2004, Soones et al., 2017). The increased social isolation stemming from the COVID-19 pandemic has made homebound older adults more vulnerable to health consequences than ever. A common definition of homebound status is “going outdoors once or less than once a week” (Cohen-Mansfield et al., 2012). In Japan, the Ministry of Health, Labour and Welfare uses a screening question that assesses the need for long-term care: “Do you go out at least once a week?,” with a “No” response being classified as homebound (Ministry of Health, Labour and Welfare of Japan, 2012).

Longitudinal studies have identified several risk factors for homebound status, including reduced functional instrumental activities of daily living (IADL) and obesity (Cohen-Mansfield et al., 2012; Jensen et al., 2006). Studies have identified social risk factors for becoming homebound, including low social role (Yamagata et al., 2020) and poor social networks (Sakurai et al., 2019), yet little is known about the types of social activities associated with homebound status. It is crucial to identify modifiable protective and high-risk social activities for homebound status to provide evidence-based community health activities for older adults.

As physical function and social activity can differ between the young old aged 65–74 and the oldest old aged 75 and over, it is important to assess the social activities for homebound status in these two groups. Some have suggested that anticipating the needs of older adults according to age requires using age-disaggregated data (World Health Organization, 2017, Das Gupta et al., 2020). To our knowledge, only one study in Japan has examined the risk factors of becoming homebound for the young and the oldest old in a suburban population (Uemura et al., 2018). The study found the predictors of becoming homebound to be at a low level of the social role among the young old and so was limited contact with friends among the oldest old. Virtually nothing is known about whether protective and high-risk social activities for the homebound status differ between the young and oldest subgroups in rural areas. Therefore, this study aimed to identify, according to age groups, protective and high-risk social activities associated with homebound status among older adults in a rural agricultural community in Japan.

2. Materials and methods

2.1. Study site, participants, and data collection

The study site was Odai Town, which is located in a rural mountainous agricultural area in Mie Prefecture, Japan, having a population of about 10,000 people with population density of approximately 26 people/km2. The percentage of residents aged 65 and over was 39.8 % in the town, considerably higher than the national average (26.7 % in 2015) (Cabinet Office of Japan, 2016). We focused on a rural area because, given the scarcity of resources in rural areas, self-reliant proactive social activities are essential to prevent homebound status. Under the long-term care insurance system, older adults can utilize long-term care services with certification by their municipal governments (i.e., cities, towns, and villages) depending on their physical and cognitive status. Even if not certified, older adults can participate in long-term care prevention programs planned and managed by the municipalities (Ministry of Health, Labour and Welfare of Japan, 2016). We used data from the town’s Survey on Social Welfare and Long-Term Care Insurance for the Elderly, which was a cross-sectional survey conducted in 2014 by the local health and welfare administrators. The survey comprehends the needs of older adults in the town for the development of a better plan to prevent the need for long-term care and promote welfare. The participants were residents aged 65 years and older who were not receiving long-term care at home. Town administrators mailed self-administered anonymous questionnaires to 3,066 all eligible older adults, 1,718 were completed and returned (56.0 %). According to estimates, the percentage of older individuals (those over 65) would rise in the developed regions of the world from 17.6 % in 2015 to 27.8 % by 2050 (United Nations, 2019), which is similar to the current aging rate of Japan (26.7 % in 2015). Social activities of the older population in rural Japan remain unchanged. According to the Daily Life and Social Participation of Older Adults Survey conducted by Cabinet Office of Japan (Cabinet Office of Japan, 2021), popular social activities practiced by older adults (ages ≥ 60) in the past one year saw similar trends in 2013 and 2021. The most popular were activities related to health and sports (33.7 % vs 26.5 %), followed by hobbies (21.4 % vs 14.5 %), community events (19.0 % vs 12.8 %), and improving living environment (9.0 % vs 9.8 %). Thus, it is crucial to present the findings of our research because they are still relevant to current situation in Japan and can help other nations address health-related challenges among the aging population.

Questionnaires missing data of homebound status, age, or gender were omitted from the analysis, yielding 1,564 usable cases (91.0 %). We classified those aged 65–74 as the young old and those aged 75 and above as the oldest old.

2.2. Outcome and predictor variables

As an outcome variable, homebound status was measured by the question, “Do you go out at least once a week?” with the binary response being “yes” or “no.” We categorized those who responded “no” as homebound.

Predictor variables included the respondents’ sociodemographic characteristics, physical status, psychological status, and participation in social activities.

“With whom are you living?” addressed family composition. “Do you have the following diseases (e.g., hypertension, diabetes mellitus, heart disease, musculoskeletal disease, dyslipidemia, and stroke) for which you are being treated or from which you are experiencing after-effects?” addressed current medical condition.

Activities of daily living (ADLs) were assessed by the ability to complete seven different activities without supervision or assistance (eating meals, face washing and tooth brushing, using the toilet, taking a bath, walking 50 m or more, going up and down stairs, and changing clothes) with a score ranging from 0 (lowest ADL) to 7 (highest ADL). IADLs were assessed based on whether the respondent could perform five different activities without aid: (taking a bus or train alone, buying daily necessaries, preparing meals, paying bills, and managing deposits and savings) with a score ranging from 0 (lowest IADL) to 5 (highest IADL). (Ministry of Health, Labour and Welfare of Japan, 2010) “How often are you physically active by working or farming?” addressed working or farming status with a response from 1 (not at all) to 4 (more than three times a week). “How often are you physically active by exercise or recreation?” addressed exercise and recreation status with a response from 1 (not at all) to 4 (more than three times a week). Motor functions were assessed based on the ability to perform five activities (going up and down stairs without holding onto a railing, standing up from a chair without holding anything, walking for about 15 min, having fallen down in the past year [reverse-coded item], worrying about falling [reverse-coded item]) with a score ranging from 5 (lowest motor function) to 0 (highest motor function) (Ministry of Health, Labour and Welfare of Japan, 2012).

Cognitive function was assessed using three questions (people say that I have forgotten things [reverse-coded item], I can make a phone call by checking the phone number by myself, I sometimes don’t know what month or day it is today [reverse-coded item]) with a score ranging from 3 (lowest cognitive function) to 0 (highest cognitive function) (Ministry of Health, Labour and Welfare of Japan, 2012). Depressive tendency was assessed using five items (lack a sense of fulfillment in daily life over the past two weeks, lack of enjoyment of activities that were previously enjoyable over the past two weeks, feeling lazy over the past two weeks after previously having not feeling lazy, feeling useless over the past two weeks, feeling tired over the past two weeks without a specific reason) with a score ranging from 0 (lowest depressive tendency) to 5 (highest depressive tendency) (Ministry of Health, Labour and Welfare of Japan, 2012). “How do you feel about your health status?” addressed subjective health with a response from 1 (not healthy) to 4 (healthy). Intellectual activity was assessed with four items (writing documents [to be submitted to local government or a hospital], reading newspapers, reading books or magazines, being interested in articles and programs on health) with a score ranging from 0 (lowest intellectual activity) to 4 (highest intellectual activity) (Ministry of Health, Labour and Welfare of Japan, 2010).

Participation in social activities was assessed using 15 items probing (1) visiting friends’ houses, (2) giving advice (listening to problems and lending a helping hand) to family and friends, (3) visiting sick people, (4) talking to young people, (5) participation in volunteering groups, (6) participation in group sports activities, (7) participation in group hobbies, (8) participation in senior citizens clubs, (9) participation in neighborhood associations, (10) participation in lifelong education groups, (11) participation in long-term care prevention program, (12) participation in activities to support older adults with care needs, (13) participation in activities to support parents with childcare needs, (14) participation in activities to improve the community environment, and (15) participation in activities to pass down culture. For items (1)–(4), participants responded “Yes” or “No” to the activity. For items (5)–(15), participants indicated the frequency of the activity, and we dichotomized as “Participation” or “NO-participation”.

2.3. Data analysis

We first calculated descriptive statistics and conducted bivariate analyses using Fisher’s exact test or chi-square test. The test of statistical significance was set at p < 0.05. We then conducted logistic regression models by the forced entry method to identify predictors of homebound status among the young and the oldest old, controlling for potential confounding variables (i.e., sociodemographic characteristics, physical status, and psychological status). We calculated the adjusted odds ratios (AOR) and 95 % confidence interval (CI) for each variable. All statistical analyses were performed in IBM SPSS Statistics 26 for Windows (IBM Corp, Armonk, NY, USA).

2.4. Ethical approval and consent to participate

Opt-out recruitment was adopted to obtain consent in this study. The study protocol was approved by the local community authority and the Clinical Research Ethics Review Committee of Mie University Hospital, in 2019 (No. U2019-018, June 19, 2019).

3. Results

3.1. Participants’ characteristics

Among the participants in the full sample (N = 1,564), ages ranged from 65 to 97, with a mean age of 75.2 (standard deviation [SD] 7.0). The mean age was 69.2 (SD 3.0) for the young old (aged 65–74; n = 767) and 81.0 (SD 4.5) for the oldest old (aged > 75; n = 797). Among the full sample, 10.5 % were homebound. The prevalence was higher in the oldest (15.7 %) than the young (5.2 %) group (p < 0.001) and in the female oldest old (19.4 %) than in the male oldest old (10.9 %) (p = 0.001) (Table 1).

Table 1.

Bivariate analysis of homebound status and correlates.

 All older adults (N = 1564)
 Young old (n = 767)
 Oldest old (n = 797)
Non-homebound
(n = 1399)
 Homebound
(n = 165)
 P
 Non-homebound
(n = 727)
 Homebound
(n = 40)
 P
 Non-homebound
(n = 672)
 Homebound
(n = 125)
 P
n % n % n % n % n % n %
Agea (n = 1564)
 Young old 727 94.8 40 5.2 <0.001
 Oldest old 672 84.3 125 15.7
 Mean ± SD 74.7 ±6.8 79.9 ±7.4 69.2 ±3.0 69.8 ±3.2 80.6 ±4.3 83.1 ±5.1
Gendera (n = 1564)
 Male 647 91.5 60 8.5 0.016 337 93.9 22 6.1 0.330 310 89.1 38 10.9 0.001
 Female 752 87.7 105 12.3 390 95.6 18 4.4 362 80.6 87 19.4
Family compositiona (n = 1516)
 Living together 1147 90.5 120 9.5 0.107 618 95.2 31 4.8 0.804 529 85.6 89 14.4 0.309
 Living alone 217 87.1 32 12.9 94 94.9 5 5.1 123 82.0 27 18.0
Medical historya (n = 1564)
 No 332 89.2 40 10.8 0.923 205 95.3 10 4.7 0.722 127 80.9 30 19.1 0.220
 Yes 1067 89.5 125 10.5 522 94.6 30 5.4 545 85.2 95 14.8
Activities of daily livingb (n = 1511)
 0 (lowest) 0 0.0 0 0.0 <0.001 0 0.0 0 0.0 0.001 0 0.0 0 0.0 <0.001
 1 0 0.0 2 100.0 0 0.0 0 0.0 0 0.0 2 100.0
 2 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
 3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
 4 2 66.7 1 33.3 1 100.0 0 0.0 1 50.0 1 50.0
 5 11 57.9 8 42.1 1 50.0 1 50.0 10 58.8 7 41.2
 6 29 64.4 16 35.6 5 71.4 2 28.6 24 63.2 14 36.8
 7 (highest) 1319 91.5 123 8.5 712 95.4 34 4.6 607 87.2 89 12.8
Instrumental activities of daily livingb (n = 1487)
 0 (lowest) 3 18.8 13 81.3 <0.001 1 16.7 5 83.3 <0.001 2 20.0 8 80.0 <0.001
 1 4 50.0 4 50.0 0 0.0 1 100.0 4 57.1 3 42.9
 2 9 69.2 4 30.8 3 100.0 0 0.0 6 60.0 4 40.0
 3 15 65.2 8 34.8 2 100.0 0 0.0 13 61.9 8 38.1
 4 86 86.0 14 14.0 35 97.2 1 2.8 51 79.7 13 20.3
 5 (highest) 1223 92.2 104 7.8 670 95.4 32 4.6 553 88.5 72 11.5
Working or farmingb (n = 1496)
 1 (not at all) 78 71.6 31 28.4 <0.001 33 82.5 7 17.5 <0.001 45 65.2 24 34.8 <0.001
 2 (less than once a week) 94 80.3 23 19.7 41 87.2 6 12.8 53 75.7 17 24.3
 3 (once or twice a week) 192 85.3 33 14.7 98 95.1 5 4.9 94 77.0 28 23.0
 4 (more than three times a week) 982 94.0 63 6.0 537 96.6 19 3.4 445 91.0 44 9.0
Exercise or recreationb (n = 1506)
 1 (not at all) 173 76.9 52 23.1 <0.001 90 87.4 13 12.6 <0.001 83 68.0 39 32.0 <0.001
 2 (less than once a week) 164 86.3 26 13.7 85 91.4 8 8.6 79 81.4 18 18.6
 3 (once or twice a week) 295 88.3 39 11.7 169 94.9 9 5.1 126 80.8 30 19.2
 4 (more than three times a week) 723 95.5 34 4.5 370 97.9 8 2.1 353 93.1 26 6.9
Motor functionb (n = 1479)
 0 (highest) 598 97.6 15 2.4 <0.001 399 98.3 7 1.7 <0.001 199 96.1 8 3.9 <0.001
 1 323 92.0 28 8.0 173 93.5 12 6.5 150 90.4 16 9.6
 2 196 87.5 28 12.5 79 96.3 3 3.7 117 82.4 25 17.6
 3 119 79.3 31 20.7 40 81.6 9 18.4 79 78.2 22 21.8
 4 65 67.7 31 32.3 13 76.5 4 23.5 52 65.8 27 34.2
 5 (lowest) 27 60.0 18 40.0 7 63.6 4 36.4 20 58.8 14 41.2
Cognitive functionb (n = 1494)
 0 (highest) 867 92.8 67 7.2 <0.001 489 97.0 15 3.0 <0.001 378 87.9 52 12.1 0.001
 1 369 88.9 46 11.1 181 93.3 13 6.7 188 85.1 33 14.9
 2 93 79.5 24 20.5 40 87.0 6 13.0 53 74.6 18 25.4
 3 (lowest) 16 57.1 12 42.9 3 42.9 4 57.1 13 61.9 8 38.1
Depressive tendencyb (n = 1361)
 0 (lowest) 738 95.3 36 4.7 <0.001 457 97.6 11 2.4 <0.001 281 91.8 25 8.2 0.001
 1 225 87.5 32 12.5 105 89.7 12 10.3 120 85.7 20 14.3
 2 110 89.4 13 10.6 47 97.9 1 2.1 63 84.0 12 16.0
 3 71 86.6 11 13.4 31 96.9 1 3.1 40 80.0 10 20.0
 4 47 82.5 10 17.5 21 84.0 4 16.0 26 81.3 6 18.8
 5 (highest) 50 73.5 18 26.5 18 78.3 5 21.7 32 71.1 13 28.9
Subjective healthb (n = 1476)
 1 (not healthy) 66 76.7 20 23.3 <0.001 29 85.3 5 14.7 0.005 37 71.2 15 28.8 0.004
 2 188 86.6 29 13.4 82 90.1 9 9.9 106 84.1 20 15.9
 3 796 90.7 82 9.3 428 95.7 19 4.3 368 85.4 63 14.6
 4 (healthy) 280 94.9 15 5.1 162 97.0 5 3.0 118 92.2 10 7.8
Intellectual activityb (n = 1493)
 0 (lowest) 11 44.0 14 56.0 <0.001 6 60.0 4 40.0 <0.001 5 33.3 10 66.7 <0.001
 1 36 76.6 11 23.4 16 88.9 2 11.1 20 69.0 9 31.0
 2 114 79.7 29 20.3 53 88.3 7 11.7 61 73.5 22 26.5
 3 246 86.9 37 13.1 110 92.4 9 7.6 136 82.9 28 17.1
 4 (highest) 935 94.0 60 6.0 527 97.1 16 2.9 408 90.3 44 9.7
Visit friends’ housesa (n = 1516)
 Yes 1047 94.5 61 5.5 <0.001 555 97.5 14 2.5 <0.001 492 91.3 47 0.0 <0.001
 No 320 78.4 88 21.6 163 86.2 26 13.8 157 71.7 62 28.3
Give advice to family and friendsa (n = 1497)
 Yes 1153 91.7 105 8.3 <0.001 620 95.7 28 4.3 0.007 533 87.4 77 12.6 <0.001
 No 192 80.3 47 19.7 93 88.6 12 11.4 99 73.9 35 26.1
Visit sick peoplea (n = 1534)
 Yes 1336 91.5 124 8.5 <0.001 706 95.5 33 4.5 <0.001 630 87.4 91 12.6 <0.001
 No 42 56.8 32 43.2 14 66.7 7 33.3 28 52.8 25 47.2
Talk to young peoplea (n = 1517)
 Yes 1202 91.8 108 8.2 <0.001 637 95.8 28 4.2 0.001 565 87.6 80 12.4 <0.001
 No 161 77.8 46 22.2 79 86.8 12 13.2 82 70.7 34 29.3
Volunteera (n = 1111)
 Participation 379 95.5 18 4.5 <0.001 233 96.7 8 3.3 0.140 146 93.6 10 6.4 <0.001
 No-participation 629 88.1 85 11.9 376 94.0 24 6.0 253 80.6 61 19.4
Sportsa (n = 1118)
 Participation 272 96.5 10 3.5 <0.001 155 98.7 2 1.3 0.011 117 93.6 8 6.4 0.001
 No-participation 742 88.8 94 11.2 450 0.0 30 6.3 292 82.0 64 18.0
Hobbya (n = 1147)
 Participation 444 95.1 23 4.9 <0.001 261 97.0 8 3.0 0.065 183 92.4 15 7.6 <0.001
 No-participation 597 87.8 83 12.2 356 93.7 24 6.3 241 80.3 59 19.7
Senior citizens cluba (n = 1163)
 Participation 330 92.7 26 7.3 0.084 104 0.0 5 4.6 0.819 226 91.5 21 8.5 <0.001
 No-participation 721 89.3 86 10.7 497 94.5 29 5.5 224 79.7 57 20.3
Neighborhood associationa (n = 1178)
 Participation 826 94.6 47 5.4 <0.001 497 95.8 22 4.2 0.081 329 92.9 25 7.1 <0.001
 No-participation 245 80.3 60 19.7 127 92.0 11 8.0 118 70.7 49 29.3
Lifelong educationa (n = 1108)
 Participation 213 95.1 11 4.9 <0.001 115 98.3 2 1.7 0.065 98 91.6 9 8.4 0.043
 No-participation 792 89.6 92 10.4 479 94.1 30 5.9 313 83.5 62 16.5
Long-term-care prevention programa (n = 1157)
 Participation 166 89.7 19 10.3 0.685 40 95.2 2 4.8 1.000 126 88.1 17 11.9 0.221
 No-participation 880 90.5 92 9.5 563 94.9 30 5.1 317 83.6 62 16.4
Activity to support older adultsa (n = 988)
 Participation 128 93.4 9 6.6 0.271 88 93.6 6 6.4 0.620 40 93.0 3 7.0 0.120
 No-participation 766 90.0 85 10.0 474 94.8 26 5.2 292 83.2 59 16.8
Activity to support parents with childcare needsa (n = 962)
 Participation 79 92.9 6 7.1 0.563 58 96.7 2 3.3 0.760 21 84.0 4 16.0 1.000
 No-participation 790 90.1 87 9.9 495 94.5 29 5.5 295 83.6 58 16.4
Activity to improve community environmenta (n = 1031)
 Participation 438 95.4 21 4.6 <0.001 286 96.3 11 3.7 0.142 152 93.8 10 6.2 <0.001
 No-participation 501 87.6 71 12.4 290 93.5 20 6.5 211 80.5 51 19.5
Activity to pass down culturea (n = 971)
 Participation 137 94.5 8 5.5 0.119 85 96.6 3 3.4 0.602 52 91.2 5 8.8 0.166
 No-participation 744 90.1 82 9.9 465 94.5 27 5.5 279 83.5 55 16.5
Open in a new tab

aFisher’s exact test. bChi-square test. Boldface indicates statistically significant differences.

The results of bivariate analysis (Table 1) showed 14 variables for the young old and 21 variables for the oldest old that were significantly correlated with homebound status.

3.2. Predictors of homebound status

Logistic regression analysis (Table 2) identified that among older adults of both age groups, the odds of being homebound were greater for those who did not visit friends’ houses (young old: AOR 5.38, 95 % CI 1.64–17.64; oldest old: AOR 3.49, 95 % CI 1.07–11.42). The odds of being homebound were greater for those who offered advice to family and friends (AOR 0.07, 95 % CI 0.01–0.62) and participated in activities to support older adults (AOR 0.17, 95 % CI 0.03–0.84). For the oldest old, in addition to visiting friends’ houses, the odds of being homebound were greater for those who did not participate in long-term care prevention programs (AOR 28.94, 95 % CI 1.90–441.63).

Table 2.

Logistic regression identifying predictors of being homebound.

 All older adults (N = 1564)
 Young old (n = 767)
 Oldest old (n = 797)
Unadjusted
 Adjusted
 Unadjusted
 Adjusted
 Unadjusted
 Adjusted
OR 95 %CI OR 95 %CI OR 95 %CI OR 95 %CI OR 95 %CI OR 95 %CI
Visit a friends’ houses
 Yes 1.00 1.00 1.00 1.00 1.00 1.00
 No 4.72 3.33 6.70 3.93 1.85 8.32 6.32 3.23 12.39 5.38 1.64 17.64 4.13 2.72 6.29 3.49 1.07 11.42
Give advice to family and friends
 Yes 1.00 1.00 1.00 1.00 1.00 1.00
 No 2.69 1.84 3.92 0.31 0.10 0.93 2.86 1.40 5.81 0.07 0.01 0.62 2.45 1.55 3.85 0.43 0.09 2.12
Visit sick people
 Yes 1.00 1.00 1.00 1.00 1.00 1.00
 No 8.21 5.00 13.47 1.60 0.49 5.23 10.70 4.05 28.28 1.31 0.08 22.06 6.18 3.45 11.07 1.46 0.32 6.64
Talk to young people
 Yes 1.00 1.00 1.00 1.00 1.00 1.00
 No 3.18 2.17 4.66 1.06 0.43 2.63 3.46 1.69 7.07 1.39 0.32 6.00 2.93 1.84 4.65 0.91 0.21 3.88
Volunteer
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 2.85 1.68 4.81 0.88 0.33 2.30 1.86 0.82 4.21 0.66 0.16 2.65 3.52 1.75 7.08 1.75 0.27 11.25
Sports
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 3.45 1.77 6.71 4.26 0.84 21.70 5.17 1.22 21.87 3.76 0.32 44.21 3.21 1.49 6.89 4.34 0.32 58.34
Hobby
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 2.68 1.66 4.33 1.00 0.39 2.53 2.20 0.97 4.97 0.88 0.23 3.29 2.99 1.64 5.43 2.06 0.32 13.11
Senior citizens club
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 1.51 0.96 2.39 0.92 0.33 2.58 1.21 0.46 3.21 1.64 0.21 12.93 2.74 1.61 4.67 0.73 0.15 3.50
Neighborhood association
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 4.30 2.86 6.47 2.17 0.87 5.43 1.96 0.92 4.14 1.75 0.44 6.93 5.46 3.23 9.24 3.54 0.64 19.54
Lifelong education
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 2.25 1.18 4.28 1.86 0.37 9.23 3.60 0.85 15.29 2.07 0.20 21.78 2.16 1.03 4.50 1.02 0.06 18.43
Long-term-care prevention program
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 0.91 0.54 1.54 5.24 0.93 29.70 1.07 0.25 4.62 0.51 0.03 9.06 1.45 0.82 2.58 28.94 1.90 441.63
Activity to support older adults
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 1.58 0.77 3.22 0.28 0.09 0.94 0.80 0.32 2.01 0.17 0.03 0.84 2.69 0.81 9.00 1.43 0.07 30.76
Activity to support parents with childcare needs
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 1.45 0.61 3.42 0.59 0.14 2.42 1.70 0.40 7.30 1.00 0.11 9.19 1.03 0.34 3.12 0.16 0.01 2.62
Activity to improve community environment
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 2.96 1.79 4.89 0.49 0.18 1.32 1.79 0.84 3.81 0.66 0.16 2.70 3.67 1.81 7.47 0.14 0.02 1.10
Activity to pass down culture
 Participation 1.00 1.00 1.00 1.00 1.00 1.00
 No-participation 1.89 0.89 3.99 0.79 0.24 2.55 1.65 0.49 5.54 1.08 0.18 6.50 2.05 0.78 5.37 0.65 0.07 6.39
Open in a new tab

Outcome variable: homebound (0: non-homebound, 1: homebound).

Models were adjusted for age, gender, family composition, medical history (e.g., hypertension, diabetes mellitus, heart disease, musculoskeletal disease, dyslipidemia, and stroke), activities of daily living (ADL), instrumental ADL, work or farm, exercise or recreation, motor function, cognitive function, depressive tendency, subjective health, and intellectual activity.

OR: odds ratio, 95%CI: 95% confidence interval. Boldface indicates statistically significant differences.

Model for the all older adults: Nagelkerke R2 = 0.368, Model for the young old: Nagelkerke R2 = 0.359, Model for the oldest old: Nagelkerke R2 = 0.513.

4. Discussion

One in ten older adults in Odai Town was homebound. There was a slight association between older age and being homebound. This is consistent with a previous study that found older age was a predictor of being homebound (Uemura et al., 2018).

Our study identified visiting friends’ houses was associated with the less homebound status among older adults of both age groups. Those who visit their friends were about three (the oldest old) to five (the young old) times less likely to be homebound. For generations, visiting friends has been a typical social activity for rural older adults. Our finding is similar to those of a study in urban and suburban Japan showing that social role (Yamagata et al., 2020) and social networks (Sakurai et al., 2019) were related to homebound status. However, in our sample, one in four older adults did not visit friends. In the era of COVID-19, the life-space mobility of older adults tends to have been minimized (Rantanen et al., 2021). It is important to ensure that older adults can communicate with friends in ways that protect them from contracting COVID-19. Our findings from the survey that pre-dated the pandemic are all the more relevant and may underestimate the magnitude of the problem in the era of COVID-19.

Among the oldest old, those who participated in a long-term care prevention program were about 29 times less likely to be homebound than those who did not, but this was not a relevant for the young old. The long-term care prevention programs (e.g., maintaining physical function, cognitive function, nutrition status) are offered at a location that is convenient for older adults and where they may interact with their peers in a fun environment. These opportunities may motivate the oldest old to go out and participate. One priority of the 2006 Ministry of Health, Labour and Welfare long-term care insurance system was preventing older adults from becoming homebound (Ministry of Health, Labour and Welfare of Japan, n.d.). The 2015 revision indicated that long-term care prevention involved not only public organizations but also diverse stakeholders including community members and non-profit organizations (Ministry of Health, Labour and Welfare of Japan, 2015). Our study shows that in this rural community, it is necessary to create and maintain long-term care prevention opportunities for the oldest old can participate in safely (particularly in the era of COVID-19).

Among the young old, the odds of being homebound were greater for those who support other older adults and offer advice to family and friends. Caring for the oldest old limits opportunities for the young old to venture outside even though they wish to do so. In our study, a higher percentage of the young old as compared to the oldest old provided support for other older adults. In Japan, among older adults who received long-term care at home, 59.7 % of caregivers were also older adults (Ministry of Health, Labour and Welfare of Japan, 2019). Being a caregiver is associated with limited personal leisure time (Rokicka and Zajkowska, 2020) and lower psychological well-being (Pinquart and Sörensen, 2003, Gilhooly et al., 2016). The COVID-19 pandemic has led to higher caregiving burden (Cohen et al., 2021), causing them additional burnout. To prevent becoming homebound, it is important to ensure that older caregivers receive respite care to reduce their burden.

Particularly in rural areas, older caregivers may have high caregiving burden. The ageing rate (proportion of people age ≥ 65) is higher in rural areas than it is in urban areas (29.4 %–38.5 % vs 25.2 % in 2015) (Ministry of Agriculture, Forestry and Fisheries of Japan, 2019). Caregivers in rural areas sometimes tend not to utilize health and social services for their old parents because of their internalized traditional values and their community’s principle of family caregiving (Asahara et al., 2002). This, while a recent study showed that caregivers in rural areas positively perceived tangible support from health professionals (Haya et al., 2019). Thus, to prevent rural caregivers becoming homebound, it is necessary that they are supported by the health and welfare system.

This study has several limitations. First, the study was cross-sectional; thus, we cannot determine causal relationships between homebound status and their factors. For example, whether the long-term care prevention program is truly a protective factor or whether this finding is actually a reflection of their ability to participate. Prospective longitudinal studies are required in rural communities to identify causal protective and high-risk social activities for the young and the oldest old becoming homebound. Additionally, amid the threat of COVID-19, further study is needed to explore associations between social activities and health of older adults. Second, some predictors that were not associated in the bivariate analysis were relevant in the multivariate analysis. This suggests that there may be complex underlying associations with homebound status that need to be explored further. Third, this study is focused on rural areas. Although it is not generalizable to urban areas, the study findings can be applied to rural areas with comparable conditions, such as small populations and scarce resources. Fourth, this study includes a possibility of nonresponse bias. The response rate was 56.0 %. Homebound status and social activities may be underestimated if homebound or less active people are least likely to respond.

5. Conclusions

Results from our analysis showed that there are protective and high-risk social activities against becoming homebound for different age groups. Both the rural young and the oldest old who were homebound found that visiting friends was a protective social activity. Two social activities revealed a risk association with the homebound status of the young old (supporting other older adults and giving advice to family and friends). Conversely, one social activity showed a protective association for the oldest old (participation in a long-term care prevention program). Any supports initiated to prevent rural older adults from becoming homebound should be based on the protective or high-risk social activities for different age groups.

CRediT authorship contribution statement

Mayumi Mizutani: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft. Ritsuko Nishide: Conceptualization, Methodology, Project administration, Writing – review & editing. Susumu Tanimura: Conceptualization, Formal analysis, Methodology, Writing – review & editing. Hiroyo Hatashita: Conceptualization, Methodology, Supervision, Writing – review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Acknowledgments

We are grateful to the older adults of Odai Town for their participation in this study. We are also grateful to the Health Department of Odai Town for its cooperation.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The data that has been used is confidential.

References

  1. Asahara K., Momose Y., Murashima S. Family caregiving of the elderly and Long-Term Care Insurance in rural Japan. Int. J. Nurs. Pract. 2002;8(3):167–172. doi: 10.1046/j.1440-172x.2002.00358.x. [DOI] [PubMed] [Google Scholar]
  2. Cabinet Office of Japan. Daily Life and Social Participation of Older Adults Survey 2021. 2022. https://www8.cao.go.jp/kourei/ishiki/r03/zentai/pdf_index.html (accessed August 21, 2022).
  3. Cabinet Office of Japan. Annual report on the ageing society 2016. https://www8.cao.go.jp/kourei/whitepaper/w-2016/zenbun/28pdf_index.html (accessed September 11, 2021).
  4. Cohen, S.A., Kunicki, Z.J., Drohan, M.M., et al. 2021. Exploring changes in caregiver burden and caregiving intensity due to COVID-19. Gerontol. Geriatr. Med. 7:2333721421999279. [DOI] [PMC free article] [PubMed]
  5. Cohen-Mansfield J., Shmotkin D., Hazan H. Homebound older persons: prevalence, characteristics, and longitudinal predictors. Arch. Gerontol. Geriatr. 2012;54:55–60. doi: 10.1016/j.archger.2011.02.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Das Gupta D., Kelekar U., Rice D. Associations between living alone, depression, and falls among community-dwelling older adults in the US. Prevent. Med. Rep. 2020;20 doi: 10.1016/j.pmedr.2020.101273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gilhooly K.J., Gilhooly M.L.M., Sullivan M.P., et al. A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC Geriatr. 2016;16:1–8. doi: 10.1186/s12877-016-0280-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hamazaki Y., Morikawa Y., Morimoto S., et al. Difference in the impact of homebound status on functional decline between independent older men and women: a 2 year follow-up study. Jpn J. Nurs. Sci. 2016;13:265–275. doi: 10.1111/jjns.12109. [DOI] [PubMed] [Google Scholar]
  9. Haya M.A.N., Ichikawa S., Wakabayashi H., Takemura Y. Family caregivers’ perspectives for the effect of social support on their care burden and quality of life: a mixed-method study in rural and sub-urban central Japan. Tohoku J. Exp. Med. 2019;247(3):197–207. doi: 10.1620/tjem.247.197. [DOI] [PubMed] [Google Scholar]
  10. Jensen G.L., Silver H.J., Roy M.-A., et al. Obesity is a risk factor for reporting homebound status among community-dwelling older persons. Obesity. 2006;14:509–517. doi: 10.1038/oby.2006.66. [DOI] [PubMed] [Google Scholar]
  11. Katsumata Y., Arai A., Tamashiro H. Contribution of falling and being homebound status to subsequent functional changes among the Japanese elderly living in a community. Arch. Gerontol. Geriatr. 2007;45:9–18. doi: 10.1016/j.archger.2006.07.005. [DOI] [PubMed] [Google Scholar]
  12. Kono A., Kai I., Sakato C., et al. Frequency of going outdoors: a predictor of functional and psychosocial change among ambulatory frail elders living at home. J. Gerontol. Ser. A, Biol. Sci. Med. Sci. 2004;59:275–280. doi: 10.1093/gerona/59.3.m275. [DOI] [PubMed] [Google Scholar]
  13. Ministry of Agriculture, Forestry and Fisheries of Japan. Nouson chiiki jinkou to nougyou syuuraku no syourai yosoku kekka [Estimated results on agricultural rural population agricultural area] 2019. https://www.maff.go.jp/primaff/koho/hodo/190830_15.html (accessed September 22, 2022).
  14. Ministry of Health, Labour and Welfare of Japan. Nichijou seikatsu keniki needs chousa model jigyou kekka houkokusho [Report on a model project for a needs survey in daily living areas]. 2010. https://www.mhlw.go.jp/topics/kaigo/dl/tp101027-01c.pdf (accessed August 8, 2020).
  15. Ministry of Health, Labour and Welfare of Japan. Kaigo yobou manual (Manual for preventing long-term care). 2012. https://www.mhlw.go.jp/topics/2009/05/tp0501-1.html (accessed August 8, 2020).
  16. Ministry of Health, Labour and Welfare of Japan. Kaigo yobou nichijou seikatsu shien sougou jigyou no tekisetsu katsu yuukou na jisshi wo hakaru tame no shishin [Guideline for appropriate and effective implementation of comprehensive program on long-term care prevention and daily life support], 2015. https://www.mhlw.go.jp/file/06-Seisakujouhou-12300000-Roukenkyoku/0000184376.pdf (accessed September 2, 2021).
  17. Ministry of Health, Labour and Welfare of Japan. Long-term care insurance system of Japan. 2016. https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_e.pdf (accessed September 11, 2022).
  18. Ministry of Health, Labour and Welfare of Japan. Comprehensive Survey of Living Conditions 2019. https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa19/index.html (accessed May 8, 2021).
  19. Ministry of Health, Labour and Welfare of Japan. Kaigo hoken seido kaikaku no gaiyou [Summary on long-term care system reform]. n.d. https://www.mhlw.go.jp/topics/kaigo/topics/0603/dl/data.pdf (Accessed September 2, 2021).
  20. Pinquart M., Sörensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol. Aging. 2003;18:250–267. doi: 10.1037/0882-7974.18.2.250. [DOI] [PubMed] [Google Scholar]
  21. Rantanen T., Eronen J., Kauppinen M., et al. Life-space mobility and active aging as factors underlying quality of life among older people before and during COVID-19 lockdown in Finland: a longitudinal study. J. Gerontol. A Biol. Sci. Med. Sci. 2021;76:e60–e67. doi: 10.1093/gerona/glaa274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rokicka M., Zajkowska O. Informal elderly caregiving and time spent on leisure: evidence from time use survey. Ageing Int. 2020;45:393–410. [Google Scholar]
  23. Sakurai R., Kawai H., Suzuki H., et al. Poor social network, not living alone, is associated with incidence of adverse health outcomes in older adults. J. Am. Med. Dir. Assoc. 2019;20:1438–1443. doi: 10.1016/j.jamda.2019.02.021. [DOI] [PubMed] [Google Scholar]
  24. Soones T., Federman A., Leff B., Siu A.L., Ornstein K. Two-year mortality among homebound, older adults: an analysis of the National Health and Aging Trends Study. J Am Geriatr Soc. 2017;65(1):123–129. doi: 10.1111/jgs.14467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Uemura K., Makizako H., Lee S., Doi T., Lee S., Tsutsumimoto K., et al. The impact of sarcopenia on incident homebound status among community-dwelling older adults: a prospective cohort study. Maturitas. 2018;113:26 -31. doi: 10.1016/j.maturitas.2018.03.007. [DOI] [PubMed] [Google Scholar]
  26. United Nations. World population prospects 2019. https://population.un.org/wpp/Download/Standard/Population/ (accessed June 11, 2022).
  27. World Health Organization. Global strategy and action plan on ageing and health. 2017. https://www.who.int/ageing/WHO-GSAP-2017.pdf (accessed September 2, 2021).
  28. Yamagata E., Watanabe Y., Kimura M., et al. Tairyoku sokuteikai sanka no koureisha ni okeru tojikomori ni kansuru joutai no 2 nenkan no henka to kanren youin [Changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years] Japanese J. Public Health. 2020;67:369–379. doi: 10.11236/jph.67.6_369. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that has been used is confidential.

Articles from Preventive Medicine Reports are provided here courtesy of Elsevier

RESOURCES