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A mortality comparison of participants and non-participants in a comprehensive health examination among elderly people living in an urban Japanese community

  • Section on Longitudinal Studies
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Abstract

Background and aims: Recent studies have revealed that there are critical differences between participants and non-participants in health examinations. The aim of this study was to examine mortality differences between participants and non-participants in a comprehensive health examination for prevention of geriatric syndromes among community-dwelling elderly people, using a three-year prospective cohort study. Methods: The study population included 854 adults aged 70 to 84 at baseline. The following items were all studied: the status of participation in the comprehensive health examination as an independent variable, age, gender, number of years of education, living alone, presence of chronic diseases, experience of falls over one year, history of hospitalization over one year, self-rated health, body mass index, instrumental activities of daily living, and subjective well-being as covariates; and all-cause mortality during a three-year follow-up as a dependent variable. Results: In an adjusted Cox’s proportional hazard regression model, the mortality risk for participants in the comprehensive health examination was significantly lower than that of non-participants (Risk Ratio (for participants)=0.44, 95% confidence interval=0.24 to 0.78). Conclusions: The present study shows that there is a large mortality difference between participants and non-participants. Our findings suggest two possible interpretations: 1) There is a bias due to self-selection for participation in the trial, which was not eliminated by adjustment for the covariates in the statistical model; 2) There is an intervention effect associated with participation in the comprehensive health examination which reduces the mortality risk.

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References

  1. Deeg DJ, Haga H, Yasumura S, Suzuki T, Shichita K, Shibata H. Predictors of 10-year change in physical, cognitive and social function in Japanese elderly. Arch Gerontol Geriatr 1992; 15: 163–79.

    Article  PubMed  CAS  Google Scholar 

  2. Ishizaki T, Watanabe S, Suzuki T, Shibata H, Haga H. Predictors for functional decline among nondisabled older Japanese living in a community during a 3-year follow-up. J Am Geriatr Soc 2000; 48: 1424–9.

    PubMed  CAS  Google Scholar 

  3. Reuben DB. Geriatric syndromes. In: Beck AC, ed. Geriatric Review Syllabus, 2nd Ed. New York: American Geriatrics Society, 1991: 117–231.

    Google Scholar 

  4. Flacker JM. What is a geriatric syndrome anyway? J Am Geriatr Soc 2003; 51: 574–6.

    Article  PubMed  Google Scholar 

  5. Kubo H, Nakayama K, Ebihara S, Sasaki H. Medical treatments and care for geriatric syndrome: new strategies learned from frail elderly. Tohoku J Exp Med 2005; 205: 205–14.

    Article  PubMed  Google Scholar 

  6. Suzuki T, Kim H, Yoshida H, Ishizaki T. Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. J Bone Miner Metab 2004; 22: 602–11.

    Article  PubMed  Google Scholar 

  7. Suzuki T, Iwasa H, Yoshida H, et al. Comprehensive health examination (“Otasha-Kenshin”) for the prevention of geriatric syndromes and a bed-ridden state in the community elderly. 1. Differences in characteristics between participants and non-participants. Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health) 2003; 50: 39–48.

    Google Scholar 

  8. Iwasa H, Suzuki T, Yoshida H, et al. Cognitive function as the factor determining higher-level competence in community-dwelling elderly: comprehensive health examination for the community elderly for the prevention of the geriatric syndrome and a bed-ridden state (“Otasha-kenshin”). Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health) 2003; 50: 950–8.

    Google Scholar 

  9. Friedman GD, Collen MF, Fireman BH. Multiphasic health check-up evaluation: a 16-year follow-up. J Chronic Dis 1986; 39: 453–63.

    Article  PubMed  CAS  Google Scholar 

  10. Shinsho F, Fukuda H, Murakami S, Takatorige T, Nakanishi N, Tatara K. Analysis on the relationship between use of health check-ups and medical care by elderly patients. A study on urban cities with high health check-up rates. Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health) 2001; 48: 314–23.

    CAS  Google Scholar 

  11. Nakahara T. Public health policies and strategies in Japan. In: Detels R, Holland WW, McEwen J, Omenn GS (Eds.), Oxford Textbook of Public Health, 3rd Edition. New York: Oxford University Press, 1997: 323–9.

    Google Scholar 

  12. Stone DH, Crisp AH. The effect of multiphasic screening on aspects of psychiatric status in middle age: results of a controlled trial in general practice. Int J Epidemiol 1978; 7: 331–4.

    Article  PubMed  CAS  Google Scholar 

  13. Norton MC, Breitner JC, Welsh KA, Wyse BW. Characteristics of nonresponders in a community survey of the elderly. J Am Geriatr Soc 1994; 42: 1252–6.

    PubMed  CAS  Google Scholar 

  14. Reuben DB, Posey E, Hays RD, Lim ME. Predictors of patient refusal to participate in ambulatory-based comprehensive geriatric assessment. J Gerontol 1994; 49: M209–15.

    Article  PubMed  CAS  Google Scholar 

  15. Hebert R, Bravo G, Korner-Bitensky N, Voyer L. Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects. J Clin Epidemiol 1996; 49: 373–81.

    Article  PubMed  CAS  Google Scholar 

  16. Ives DG, Traven ND, Kuller LH, Schulz R. Selection bias and non-response to health promotion in older adults. Epidemiology 1994; 5: 456–61.

    Article  PubMed  CAS  Google Scholar 

  17. Launer LJ, Wind AW, Deeg DJ. Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. Am J Epidemiol 1994; 139: 803–12.

    PubMed  CAS  Google Scholar 

  18. Osler M, Schroll M. Differences between participants and non-participants in a population study on nutrition and health in the elderly. Eur J Clin Nutr 1992; 46: 289–95.

    PubMed  CAS  Google Scholar 

  19. Suzuki KJ, Nakaji S, Tokunaga S, Shimoyama T, Umeda T, Sugawara K. Confounding by dietary factors in case-control studies on the efficacy of cancer screening in Japan. Eur J Epidemiol 2005; 20: 73–8.

    Article  PubMed  Google Scholar 

  20. Otto SJ, Schroder FH, de Koning HJ. Low all-cause mortality in the volunteer-based Rotterdam section of the European randomised study of screening for prostate cancer: self-selection bias? J Med Screen 2004; 11: 89–92.

    Article  PubMed  CAS  Google Scholar 

  21. Minder CE, Muller T, Gillmann G, Beck JC, Stuck AE. Subgroups of refusers in a disability prevention trial in older adults: baseline and follow-up analysis. Am J Public Health 2002; 92: 445–50.

    Article  PubMed  Google Scholar 

  22. Shimonaka Y, Nakazato K, Kawaai C, Sato S, Ishihara O, Gondo Y. The effect of life events on psychological well-being among Japanese middle-aged and elderly. In: Shibata H, Suzuki T, Shimonaka Y (Eds.), Facts research and intervention in geriatrics 1997. Longitudinal Interdisciplinary Study on Aging. Paris: Serdi Publisher, 1997: 137–46.

    Google Scholar 

  23. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.

    CAS  Google Scholar 

  24. Salthouse TA. What do adult age differences in the Digit Symbol Substitution Test reflect? J Gerontol 1992; 47: P121–8.

    Article  PubMed  CAS  Google Scholar 

  25. Epker MO, Lacritz LH, Munro Cullum C. Comparative analysis of qualitative verbal fluency performance in normal elderly and demented populations. J Clin Exp Neuropsychol 1999; 21: 425–34.

    Article  PubMed  CAS  Google Scholar 

  26. Koyano W, Shibata H, Nakazato K, Haga H, Suyama Y. Measurement of competence: reliability and validity of the TMIG Index of Competence. Arch Gerontol Geriatr 1991; 13: 103–16.

    Article  PubMed  CAS  Google Scholar 

  27. Lawton MP. The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol 1975; 30: 85–9.

    Article  PubMed  CAS  Google Scholar 

  28. Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric assessment in well-functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 1999; 47: 389–95.

    PubMed  CAS  Google Scholar 

  29. Saltvedt I, Saltnes T, Mo ES, Fayers P, Kaasa S, Sletvold O. Acute geriatric intervention increases the number of patients able to live at home. A prospective randomized study. Aging Clin Exp Res 2004; 16: 300–6.

    Google Scholar 

  30. Vass M, Avlund K, Hendriksen C, Andersen CK, Keiding N. Preventive home visits to older people in Denmark: methodology of a randomized controlled study. Aging Clin Exp Res 2002; 14: 509–15.

    PubMed  Google Scholar 

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Correspondence to Hajime Iwasa PhD.

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Iwasa, H., Yoshida, H., Kim, H. et al. A mortality comparison of participants and non-participants in a comprehensive health examination among elderly people living in an urban Japanese community. Aging Clin Exp Res 19, 240–245 (2007). https://doi.org/10.1007/BF03324696

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