The Relationship between ADL, Lifestyle Factors, and Stress among Community-Dwelling Elderly Using Home-Visit Rehabilitation Services in Iwaki City, Fukushima Prefecture
Atsushi Kitayama, Kei Miyoshi, Shinichi Saito
Background: In Japan, the rapid aging of the population has made the mental health of the elderly
a critical issue. Numerous studies have reported that stress in the elderly is closely related to mental
disorders. These mental disorders may lead to a decline in Activities of Daily Living (ADL) capabilities
and subsequently a decrease in Quality of Life (QOL). Therefore, it is crucial for therapists to identify
and address stress factors early in elderly residents to enhance their QOL and ADL.
Objective: This study aims to elucidate the relationship between stress and lifestyle factors and habits
among elderly residents in Iwaki City, Fukushima Prefecture, who are using home-visit nursing
rehabilitation services. It also seeks to clarify the association between the ADL capabilities and stress
levels of the subjects.
Methods: The study included 61 elderly individuals aged 65 and above residing in Iwaki City and
utilizing home-visit nursing rehabilitation services. Stress levels were measured using the General Health
Questionnaire (GHQ28), and the total scores and scores for each item were calculated. A questionnaire
was used to investigate lifestyle factors and habits. The relationships between the GHQ scores (total and
each item) and lifestyle factors, as well as between ADL capabilities and GHQ scores, were analyzed.
Results: To select independent variables, univariate analysis was conducted, revealing significant
associations with four items: physical fitness, economic status, future planning, and alcohol consumption.
In Analysis 1, logistic regression was performed with GHQ28 item scores and total scores as dependent
variables, and the four identified items as independent variables. The results indicated a strong association
between stress and subjective physical fitness and economic status. In Analysis 2, logistic regression was
performed with the Barthel Index (BI) scores as the dependent variable and the four GHQ28 items as
independent variables. Significant associations were found between ADL capabilities and two GHQ
items: anxiety/insomnia and depression. Anxiety and insomnia showed a stronger association with ADL
capabilities than depression.
Discussion: This study did not find a significant relationship between stress and lifestyle habits in
community-dwelling elderly individuals. However, previous studies have reported various stress factors
for this population. The study focused on individuals with ADL disabilities receiving long-term care
insurance. Subjective physical fitness and economic status were strongly related to stress, suggesting
these as effective indicators for evaluating stress levels. For ADL capabilities, significant associations
were found with anxiety/insomnia and depression, indicating that mental symptoms due to stress might
impede ADL capabilities more than physical symptoms. Home-visit rehabilitation services should adopt
a comprehensive approach to maintain the mental health of the elderly, aiming to improve their QOL
and support successful aging.
