The characteristics of the study participants are presented in Table 1, and the highlights are as follows: 37.7% were aged over 70 years, 58.4% were female, 41.6% were male, approximately 19.6% were non-married, and 66.7% had been diagnosed with one or more chronic diseases. 12.8% of the participants were assessed as having dependency, and no significant difference between males and females was observed.
Table 1
Characteristics of study participants in the study
Variable categories
|
n
|
%
|
Characteristic variables (n, %)
|
|
|
Sex
|
|
|
Male
|
380
|
41.6
|
Female
|
533
|
58.4
|
Age (yr)
|
|
|
60–69
|
569
|
62.3
|
≥70
|
344
|
37.7
|
Marital status
|
|
|
Married
|
734
|
80.4
|
Non-married
|
179
|
19.6
|
Education levels (yr)
|
|
|
0–6
|
176
|
19.3
|
7–9
|
353
|
38.7
|
10–12
|
211
|
23.1
|
13+
|
173
|
18.9
|
Individual income
|
|
|
¥0 to 1,999
|
550
|
60.2
|
¥2,000 to 3,999
|
230
|
25.2
|
¥4,000 to 5,999
|
87
|
9.5
|
¥6,000 and Over
|
46
|
5.1
|
Smoking status
|
|
|
Yes
|
126
|
13.8
|
No
|
787
|
86.2
|
Alcohol use
|
|
|
Yes
|
186
|
20.4
|
No
|
727
|
79.6
|
Physical activity
|
|
|
Yes
|
360
|
39.4
|
No
|
553
|
60.6
|
Chronic disease status
|
|
|
Yes
|
611
|
66.9
|
No
|
302
|
33.1
|
Measured Variables (Mean, SD)
|
|
|
Dependency scores
|
43.4
|
12.8
|
GDS-15 scores
|
3.4
|
3.0
|
EPQ scores
|
22.3
|
4.1
|
GDS-15: the 15-item Geriatric Depression Scale |
EPQ: the Eysenck Personality Questionnaire |
The tree graph by cluster analysis is presented in Fig. 2. The 34 variables of the community environment that were significantly associated with dependency were divided into six categories. The first category can be summarized as follows: community primary preventive care service resources (e.g., diet and health guidance for elderly and chronic patients), contracted family doctor services, screening for common diseases, regular home visits for the elderly living alone and disabled, the utilization of electronic health records, and holding regular lectures on general health knowledge. Other community environment variables can be classified into the following categories: utilization of and satisfaction with community services, community culture, and basic living facilities; psychological, cognitive, and comprehensive nursing resources; employment and caregiver guidance organizations; and home living support services. We put the score of dependency into the cluster analysis model to investigate the association between the score of dependency and the environmental resources of the community. The score of dependency was classified into the category of community primary preventive care service resources, and no significant change in those variables in another category was observed.
Table 2 presents the odds ratios (ORs) of the community environment resources for dependency using logistic regression models. The participants who responded “yes” to “Do you think it is necessary for community medical staff to assess your health status” and “if there is a short-term care home for the elderly in your community” were compared with the participants who responded “no” to the same items. The result was as follows: these community environment variables were significantly positively associated with levels of dependency in the logistic regression analysis, namely the OR was 2.10 (95% CI, 1.33–3.34, P = 0.001) and 2.40 (95% CI, 1.40–4.09, P = 0.001). Other community environmental resources such as the community geriatric ward,regular lectures on health knowledge, and screening for common diseases were also positively associated with levels of dependency: the OR was 1.97 (95% CI, 1.23–3.18, P = 0.005),1.50 (95% CI, 1.06–2.14, P = 0.023), and 1.56 (95% CI, 1.05–2.34, P = 0.029), respectively. The community cultural activity center, supermarket or agricultural market, and volunteer service were negatively associated with levels of dependency: the OR was 0.50 (95% CI, 0.34–0.69, P < 0.001),0.57 (95% CI, 0.38–0.86, P = 0.007), and 0.56 (95% CI, 0.40–0.79, P = 0.001), respectively.
Table 2
The odds ratios of community environment resources and other related risk factors for dependency by logistic regression models
Variables
|
Multivariable adjusted
Odds Ratios
|
|
|
|
95% CI
|
P value
|
Received community health services (times)
|
1.27
|
1.08
|
1.48
|
0.004
|
The need for health assessment (n/y)
|
2.10
|
1.33
|
3.34
|
0.001
|
Community geriatric ward (n/y)
|
1.97
|
1.23
|
3.18
|
0.005
|
Short-term care home (n/y)
|
2.40
|
1.40
|
4.09
|
0.001
|
Regular lectures on health knowledge (n/y)
|
1.50
|
1.06
|
2.14
|
0.023
|
Screening for common diseases (n/y)
|
1.56
|
1.05
|
2.34
|
0.029
|
Community cultural activity center (n/y)
|
0.49
|
0.34
|
0.69
|
<0.001
|
Volunteer Service (n/y)
|
0.57
|
0.38
|
0.86
|
0.007
|
Supermarket and agricultural market (n/y)
|
0.56
|
0.40
|
0.79
|
0.001
|
Age (y)
|
1.03
|
1.01
|
1.06
|
0.004
|
Social support (score)
|
0.86
|
0.82
|
0.91
|
<0.001
|
Chronic disease status (y/n)
|
0.71
|
0.52
|
0.96
|
0.027
|
Income satisfaction (n/y)
|
1.61
|
1.39
|
1.87
|
<0.001
|
EPQ scores (points)
|
1.13
|
1.09
|
1.17
|
<0.001
|
The age-specific results by separated logistic regression models are shown in Table 3. In the group aged under 70 years, the utilization of electronic health records and the need for health assessments, rehabilitation equipment rentals, and community nursing homes were significantly associated with the levels of dependency scores: the OR was 2.81 (95% CI, 1.90–4.14, P <.0001),2.25 (95% CI, 1.24–4.06, P = 0.007) and 2.13 (95% CI, 1.02–4.43, P = 0.043), and 1.90 (95% CI, 1.12–3.24, P = 0.018), respectively. The community cultural activity center and supermarket or agricultural market were negatively associated with levels of dependency.
Table 3
The odds ratios of community environment resources for dependency by the age-specific
|
Variables
|
Multivariable adjusted
Odds Ratios
|
95% CI
|
P value
|
Age < 70
|
Received community health services
|
1.26
|
1.03
|
1.55
|
0.024
|
|
Utilization of electronic health records
|
2.81
|
1.90
|
4.14
|
< 0.001
|
|
The need for health assessment
|
2.25
|
1.24
|
4.06
|
0.007
|
|
Rehabilitation equipment rental
|
2.13
|
1.02
|
4.43
|
0.043
|
|
Community nursing home
|
1.90
|
1.12
|
3.24
|
0.018
|
|
Community cultural activity center
|
0.35
|
0.22
|
0.56
|
< 0.001
|
|
Supermarket and agricultural market
|
0.57
|
0.38
|
0.85
|
0.006
|
Age ≥ 70
|
Received community health services
|
1.49
|
1.18
|
1.88
|
< 0.001
|
|
Short-term care home
|
4.01
|
1.64
|
9.80
|
0.002
|
|
Day care and nursing service
|
2.41
|
1.13
|
5.17
|
0.024
|
|
Transportation service
|
1.86
|
1.03
|
3.36
|
0.040
|
|
Regular lectures on health knowledge
|
1.93
|
1.21
|
3.08
|
0.006
|
|
Canteens for the elderly
|
0.30
|
0.13
|
0.71
|
0.006
|
|
Volunteer Service
|
0.38
|
0.21
|
0.70
|
0.002
|
|
Cafe or tea room
|
0.50
|
0.26
|
0.95
|
0.034
|
|
Library
|
0.46
|
0.24
|
0.87
|
0.018
|
In the group aged 70 years and over, a short-term care home was strongly associated with levels of dependency: the OR was 4.01 (95% CI, 1.64–9.80, P = 0.002). The daycare and nursing service, transportation service, and regular lectures on health knowledge were associated with levels of dependency: the OR was 2.41 (95% CI, 1.13–5.17, P = 0.024), 1.86 (95% CI, 1.03–3.36, P = 0.040), and 1.93 (95% CI, 1.21–3.08, P = 0.006), respectively. The canteens for the elderly, volunteer service, libraries, and cafes or tea rooms were negatively associated with levels of dependency. The received community health services were positively associated with levels of dependency in the groups aged under as well as over 70 years.
The social support levels-stratified results using the separated logistic regression models are shown in Table 4. The number of times that community health services were received was significantly associated with levels of dependency in both the high level of social support group and the low level of social support group. In the group with a low level of social support, the following were significantly associated with levels of dependency: an emergency call or monitoring system, transportation services, the need for health assessment, and regular lectures on health knowledge: the OR was 2.42 (95% CI, 1.29–4.52, P = 0.006), 2.19 (95% CI, 1.18–4.07, P = 0.013), 1.89 (95% CI, 1.06–3.36, P = 0.031), and 1.98 (95% CI, 1.29–3.02, P = 0.002), respectively. The volunteer service and cafe or tea room were negatively associated with levels of dependency.
Table 4
The odds ratios of community environment resources for dependency by the social support levels-specific
|
Variables
|
Multivariable adjusted
Odds Ratios
|
95% CI
|
P value
|
LSS*
|
Received community health services
|
1.28
|
1.02
|
1.60
|
0.036
|
|
Emergency call or monitoring system
|
2.42
|
1.29
|
4.52
|
0.006
|
|
Transportation service
|
2.19
|
1.18
|
4.07
|
0.013
|
|
The need for health assessment
|
1.89
|
1.06
|
3.36
|
0.031
|
|
Regular lectures on health knowledge
|
1.98
|
1.29
|
3.02
|
0.002
|
|
Volunteer Service
|
0.44
|
0.25
|
0.76
|
0.004
|
|
Cafe or tea room
|
0.30
|
0.17
|
0.51
|
< 0.001
|
HSS*
|
Received community health services
|
1.54
|
1.25
|
1.89
|
< 0.001
|
|
Community geriatric ward
|
2.37
|
1.24
|
4.53
|
0.009
|
|
Short-term care home
|
2.93
|
1.37
|
6.25
|
0.006
|
|
Regular lectures on health knowledge
|
1.82
|
1.15
|
2.89
|
0.011
|
|
System of regular visits
|
1.95
|
1.25
|
3.06
|
0.004
|
|
Emergency call or monitoring system
|
0.40
|
0.21
|
0.77
|
0.006
|
|
Elder university
|
0.50
|
0.30
|
0.86
|
0.011
|
|
Supermarket and agricultural market
|
0.52
|
0.33
|
0.80
|
0.003
|
* LSS: Low levels of social support |
* HSS: High levels of social support |
In the group with a high level of social support, community geriatric ward, short-term care home, regular lectures on health knowledge, and regular home visits for the elderly who were living alone and disabled were associated with the levels of dependency: the OR was 2.37 (95% CI, 1.24–4.53, P = 0.009), 2.93 (95% CI, 1.37–6.25, P = 0.006), 1.82 (95% CI, 1.15–2.89, P = 0.011), and 1.95 (95% CI, 1.25–3.06, P = 0.004), respectively. An emergency call or monitoring system, elder universities, and a supermarket or agricultural market were negatively associated with levels of dependency.