TY - JOUR
T1 - Dose-Response Relationship Between Life-Space Mobility and Mortality in Older Japanese Adults
T2 - A Prospective Cohort Study
AU - Watanabe, Daiki
AU - Yoshida, Tsukasa
AU - Yamada, Yosuke
AU - Watanabe, Yuya
AU - Yamada, Minoru
AU - Fujita, Hiroyuki
AU - Nakaya, Tomoki
AU - Miyachi, Motohiko
AU - Arai, Hidenori
AU - Kimura, Misaka
N1 - Funding Information:
The Kyoto-Kameoka study was conducted with JSPS KAKENHI and was supported by a research grant provided to Misaka Kimura ( 24240091 ), Yosuke Yamada ( 15H05363 ), and Daiki Watanabe ( 21K17699 ); a grant and administrative support by the Kyoto Prefecture Community-based Integrated older adults Care Systems Promotion Organization since 2011; and by Kameoka City under the program of the Long-term Care Insurance and Planning Division of the Health and Welfare Bureau for the older adults , Ministry of Health, Labour and Welfare and the World Health Organization (WHO) Collaborating Centre on Community Safety Promotion.
Publisher Copyright:
© 2022 The Authors
PY - 2022/11
Y1 - 2022/11
N2 - Objectives: Some epidemiological studies of older American adults have reported a relationship between life-space mobility (LSM) and mortality. However, these studies did not show a dose-response relationship and did not include individuals from other countries. Therefore, we evaluated the dose-response relationship between LSM and mortality in older adults. Design: Prospective cohort study. Setting and Participants: We used the data of 10,014 older Japanese adults (aged ≥65 years) who provided valid responses to the Life-Space Assessment (LSA) in the Kyoto-Kameoka study in Japan. Methods: LSM was evaluated using the self-administered LSA consisting of 5 items regarding life-space from person's bedroom to outside town. The LSM score was calculated by multiplying life-space level by frequency score by independence score, yielding a possible range of 0 (constricted life-space) to 120 (broad life-space). These scores were categorized into quartiles (Qs). Mortality data were collected from July 30, 2011 to November 30, 2016. A multivariate Cox proportional hazards model that included baseline covariates were used to evaluate the relationship between LSM score and mortality risk. Results: A total of 1030 deaths were recorded during the median follow-up period of 5.3 years. We found a negative association between LSM score and overall mortality even after adjusting for confounders [Q1: reference; Q2: hazard ratio (HR) 0.81, 95% CI 0.69-0.95; Q3: HR 0.70, 95% CI 0.59-0.85; Q4: HR 0.68, 95% CI 0.55-0.84, P for trend <.001]. Similar results were observed for the spline model; up to a score of 60 points, LSM showed a strong dose-dependent negative association with mortality, but no significant differences were observed thereafter (L-shaped relationship). Conclusions and Implications: Our findings demonstrate an L-shaped relationship between LSM and mortality. This study will be useful in establishing target values for expanding the range of mobility among withdrawn older adults with a constricted life-space.
AB - Objectives: Some epidemiological studies of older American adults have reported a relationship between life-space mobility (LSM) and mortality. However, these studies did not show a dose-response relationship and did not include individuals from other countries. Therefore, we evaluated the dose-response relationship between LSM and mortality in older adults. Design: Prospective cohort study. Setting and Participants: We used the data of 10,014 older Japanese adults (aged ≥65 years) who provided valid responses to the Life-Space Assessment (LSA) in the Kyoto-Kameoka study in Japan. Methods: LSM was evaluated using the self-administered LSA consisting of 5 items regarding life-space from person's bedroom to outside town. The LSM score was calculated by multiplying life-space level by frequency score by independence score, yielding a possible range of 0 (constricted life-space) to 120 (broad life-space). These scores were categorized into quartiles (Qs). Mortality data were collected from July 30, 2011 to November 30, 2016. A multivariate Cox proportional hazards model that included baseline covariates were used to evaluate the relationship between LSM score and mortality risk. Results: A total of 1030 deaths were recorded during the median follow-up period of 5.3 years. We found a negative association between LSM score and overall mortality even after adjusting for confounders [Q1: reference; Q2: hazard ratio (HR) 0.81, 95% CI 0.69-0.95; Q3: HR 0.70, 95% CI 0.59-0.85; Q4: HR 0.68, 95% CI 0.55-0.84, P for trend <.001]. Similar results were observed for the spline model; up to a score of 60 points, LSM showed a strong dose-dependent negative association with mortality, but no significant differences were observed thereafter (L-shaped relationship). Conclusions and Implications: Our findings demonstrate an L-shaped relationship between LSM and mortality. This study will be useful in establishing target values for expanding the range of mobility among withdrawn older adults with a constricted life-space.
KW - Mobility
KW - death
KW - life-space
KW - restricted cubic spline model
KW - validation
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U2 - 10.1016/j.jamda.2022.04.017
DO - 10.1016/j.jamda.2022.04.017
M3 - Article
C2 - 35636462
AN - SCOPUS:85131376009
SN - 1525-8610
VL - 23
SP - 1869.e7-1869.e18
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 11
ER -