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Geriatr Gerontol Int 2015; 15: 910–917
ORIGINAL ARTICLE: BEHAVIORAL AND SOCIAL SCIENCES
Sense of coherence as a key to improve homebound status among older adults with urinary incontinence Kyo Takahashi,1,2 Atsushi Kato,3 Tomoyuki Igari,4 Eriko Sase,1 Akira Shibanuma,1 Kimiyo Kikuchi,1 Keiko Nanishi,1 Masamine Jimba1 and Junko Yasuoka1 1
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, 2Department of Social Rehabilitation, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, 3Japan Toilet Labo, Tokyo, and 4 Sodegaura Satsukidai Hospital, Chiba, Japan
Aim: Being homebound is regarded as a negative condition for social participation in Japan. However, little is known about the possibility of psychological resilience to prevent being homebound among older adults with urinary incontinence. The present study aimed to examine the association between sense of coherence as a measure of psychological resilience and being homebound among older adults with urinary incontinence. Methods: A cross-sectional study was carried out in Chiba, Japan. We trained 95 care managers as interviewers, and they collected the data from 411 community-dwelling frail older adults using a pretested structured questionnaire. Logistic regression analysis was run to identify factors associated with being homebound among the participants with urinary incontinence. Results: Of the participants, 158 (38.4%) had urinary incontinence. Among the participants with urinary incontinence, 52 (32.9%) were homebound. As a result of logistic regression analysis adjusting for age, sex, living status, hobby, types of prevalent diseases, walking ability, perceived social support and subjective social capital, lower meaningfulness in their lives, which is a component of a sense of coherence, remained positively associated with being homebound (adjusted odds ratio 0.79, 95% confidence interval 0.65–0.96). Conclusions: Being homebound is less prevalent among those who feel challenges, or worthy of investment or engagement in daily life. By improving a sense of meaningfulness, homebound status might be improved among older adults with urinary incontinence. To encourage active social participation of the target population, their psychological resilience (particularly meaningfulness) should be addressed more. Geriatr Gerontol Int 2015; 15: 910–917. Keywords: frail elderly, homebound persons, psychological resilience, sense of coherence, urinary incontinence.
Introduction Japan is one of the most aged countries in the world. In 2012, 23.3% of the total population was aged 65 years or older, the highest in the world.1 To support the quality of daily life of older adults and their family members, the Government of Japan introduced the long-term care insurance (LTCI) system in 2000. The LTCI classifies the users into seven levels based on the amount of support or care required: support levels
Accepted for publication 10 June 2014. Correspondence: Dr Junko Yasuoka DSc MPH, Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Email: [email protected]
910 |
doi: 10.1111/ggi.12353
1–2, and care levels 1–5. For the users, the LTCI offers various community-based care services, such as nursing home visits, day-care services and short-stay services.2 However, as the number of older adults increases, older adults’ issues are moving beyond the biological and becoming increasingly psychosocial.1–4 For example, urinary incontinence, the complaint of involuntary leakage of urine,5 is now prevalent among older adults as a result of the decline of health and negatively affects their social participation.3,6–8 Being homebound is regarded as a negative condition for social participation in Japan, while it has been also investigated in the context of older adults’ frailty in other developed countries, such as the USA.9–11 The Ministry of Health, Labor and Welfare of Japan treats being homebound as a prioritized problem in the preventive care program.12 Although the definition of being © 2014 Japan Geriatrics Society
Sense of coherence and being homebound
homebound varies, the frequency of going outdoors has been commonly used to identify being homebound in Japan.9 Specifically, one who goes outdoors once a week or less often is regarded as a homebound person.13–17 Various factors have been found to be associated with being homebound, such as cardiovascular, cerebrovascular and musculoskeletal disorders.10,11 In particular, walking ability has been treated as an essential factor to be or not to be homebound.13,14,18,19 Two longitudinal studies have identified being homebound itself as a useful predictor of the incidence of physical disability or being bedridden.19,20 However, less attention has been paid to psychological factors that could prevent being homebound. Psychological resilience might have the potential to protect older adults who experience a stressful life event, such as urinary incontinence.21 Resilience is defined as “a dynamic process encompassing positive adaptation within the context of significant adversity” by Luthar et al.22 During the past few decades, many researchers were attracted by this salutogenic concept, and explored psychological resilience factors that could buffer the negative effects of stressful life events.23–26 Although measuring psychological resilience is not easy, sense of coherence (SOC) is gaining more attention as a measure of psychological resilience in public health.27,28 Antonovsky introduced SOC as “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable (comprehensibility); the resources are available to one to meet the demands posed by these stimuli (manageability); and these demands are challenges, worthy of investment and engagement (meaningfulness).”29,30 In other words, the SOC is a specific way of viewing life as comprehensible, manageable and meaningful, and assists in responding to life’s stresses.29,31 Many studies have investigated SOC in relation to quality of life (QOL).32 For example, SOC was found as a promoting factor in QOL in several Scandinavian longitudinal studies that included older adults with lower-limb ischemia and with hip fracture.33–35 Despite a rapid accumulation of SOC studies, the experience of being homebound has not been well investigated, especially among older adults with urinary incontinence. The present study, therefore, aimed to examine the association between SOC and being homebound among community-dwelling older adults, especially those with urinary incontinence. We intentionally selected older adults with urinary incontinence, because their psychological resilience has not been well investigated despite their suffering from urinary incontinence. We hypothesized that high SOC would be inversely associated with being homebound among older adults with urinary incontinence. © 2014 Japan Geriatrics Society
Methods Study design and site A cross-sectional study was carried out from April to August 2012, using a structured questionnaire. The study sites were Futtsu city, Kimitsu city, Kisarazu city and Sodegaura city in Chiba Prefecture, Japan. These four cities are administratively regarded as one Kimitsu region under the jurisdiction of the Kimitsu Health and Welfare Center.36 The Kimitsu region is located approximately 50 km away from Tokyo, and many inhabitants are engaged in agriculture, fishery and heavy industries along the coast of Tokyo Bay. The total population in this region was 330 877, and 78 780 of them (23.8%) were aged 65 years or older on 1 April in 2012.37 Among 90 LTCI-related institutions (community comprehensive support centers, in-home care support offices) in the study site, 35 institutions cooperated with the present study. We trained 95 LTCI specialists (care managers) in these 35 institutions as interviewers to collect the data from their LTCI users.
Participants The participants were community-dwelling older adults who received a service of the LTCI. Inclusion criteria included being aged 65 years or older, living at home, being officially certified as on support level 1 or 2, or care level 1 or 2. We excluded those certified as on care levels 3, 4 and 5, as severe dementia is prevalent among them.38 Furthermore, trained care managers screened their assigned LTCI users for severe dementia, and had previously excluded those with severe dementia from the present study because of their inability to provide informed consent.
Questionnaire We developed a structured, pretested questionnaire. It included the following items: sociodemographics (age, sex, living status, hobby), certified support/care level, types of prevalent diseases (mental and behavioral, musculoskeletal system and connective tissue, genitourinary system), homebound status, walking ability, urinary incontinence, perceived social support, subjective social capital and SOC. Being homebound was defined as a condition with infrequency of going outdoors. Based on previous studies, a cut-off point was set between “once per 2–3 days or more often” and “once a week or less often,” and we regarded the latter as being homebound.13–17 Urinary incontinence, a condition with involuntary leakage of urine once a day or more often, was assessed using an item of the Barthel Index.39 We measured perceived social support and subjective social capital as environmental factors that could affect the | 911
K Takahashi et al.
association between SOC and homebound status. To measure perceived social support, we used the Multidimensional Scale of Perceived Social Support (MSPSS), which was developed by Zimet.40 For subjective social capital, we used the subjective social capital scale developed by Togari.41 The validity and reliability of these two scales were confirmed with various communitydwelling Japanese including older adults.41,42 To measure SOC, we used the SOC scale developed by Antonovsky.29 The SOC scale measures an individual’s orientation to life based on a sense of comprehensibility, manageability and meaningfulness. Yamazaki developed the Japanese version of the SOC scale, and it has been used among older adults in Japan.43,44 Among several versions, we selected the short-version of the SOC scale, which consists of 13 items (5 items for comprehensibility, 4 items for manageability, 4 items for meaningfulness) with five response levels, for its simplicity. A higher score indicates higher SOC. We observed a sufficient internal consistency with a Cronbach’s alpha of 0.83 (comprehensibility 0.72, manageability 0.59 and meaningfulness 0.53). Trained care managers filled in the questionnaires in two instalments. First, they recorded age, sex, living status, certified support/care level and types of prevalent diseases before carrying out the interviews. Second, they showed and read out other questions directly to the study participants, and recorded their verbal responses on the questionnaires. To establish the validity and reliability of the questionnaire, it was revised and pretested by two toileting experts from the Japan Toilet Labo (a non-profit organization), three health administrators from the Kimitsu Health and Welfare Center, and two health professionals and three care managers at the study site.
Data analysis Three types of statistical analyses were carried out. First, descriptive analysis was carried out to provide an overview of the characteristics of the participants. Crude associations were explored between all variables and homebound status using χ2-tests for nominal variables and independent samples t-tests for continuous variables. Second, logistic regression analysis was carried out to identify variables significantly associated with being homebound among all participants. Finally, logistic regression analysis was carried out again only among the participants with urinary incontinence. In the regression models, three components of SOC (comprehensibility, manageability and meaningfulness) were entered separately, as we focused on their different characteristics for profound interpretation and their crude associations with being homebound varied in bivariate analyses. Regarding multicollinearity, we confirmed Pearson correlation coefficients with less than 912 |
0.80 among perceived social support, subjective social capital and three SOC components.45 The computer program PASW statistics 18.0 (SPSS, Chicago, IL, USA) was used for all statistical analyses.
Ethical considerations We obtained ethical approval from the Research Ethics Committee of the Graduate School of Medicine of the University of Tokyo. The following ethical points were considered. We trained care managers who already had rapport with the participants. After explaining the principals of voluntary participation and confidentiality, we obtained written consent from all participants. A family member or trained care manager signed the consent form when a participant could not write his or her own signature because of visual or physical disability. As all participants required support and care, we developed the questionnaire to be as brief as possible to protect them from fatigue.
Results The characteristics of the 411 participants are shown in Table 1. The mean age was 82 years (SD 7.3), and 143 (34.8%) were homebound. Regarding urinary incontinence, 158 (38.4%) were incontinent. Between two groups classified by homebound status (frequency of going outdoors), living alone (P = .005) and being dependent for walking (P < .001) were positively associated with being homebound. Table 2 shows the results of logistic regression analysis predicting being homebound among all participants. Those who were older (AOR 1.04, 95% CI 1.00–1.08), those who lived alone (AOR 3.10, 95% CI 1.81–5.32) and those who were dependent for walking (AOR 3.99, 95% CI 2.35–6.76) were more likely to be homebound. Table 3 shows the results of logistic regression analysis predicting being homebound among participants with urinary incontinence. Those who were dependent for walking (AOR 3.77, 95% CI 1.58–8.98) and those who perceived higher social support (AOR 1.07, 95% CI 1.01–1.12) were more likely to be homebound. In addition, those who had a higher sense of meaningfulness in their lives, a component of SOC, were less likely to be homebound than those having a lower sense of meaningfulness (AOR 0.79, 95% CI 0.65–0.96). However, the other two components of SOC, comprehensibility and manageability, were not significantly associated with being homebound in our logistic regression analysis.
Discussion Being homebound was less prevalent among those who felt higher levels of meaningfulness; that is, they felt © 2014 Japan Geriatrics Society
Sense of coherence and being homebound
Table 1 Participant characteristics classified by homebound status (n = 411) Variables n (%)
Total 411 (100)
Homebound status (frequency of going outdoors) Once per 2–3 days Once a week P-value or more often or less often 268 (65.2) 143 (34.8)
Age† (mean ± SD) Sex Male Female Living status With family Alone Hobby One or more None Mental and behavioral No Yes Musculoskeletal system and connective tissue No Yes Genitourinary system No Yes Walking Independent Dependent Urinary incontinence Continent Incontinent Perceived social support†, mean ± SD Subjective social capital†, mean ± SD Sense of coherence†, mean ± SD Comprehensibility†, mean ± SD Manageability†, mean ± SD Meaningfulness†, mean ± SD
81.9 ± 7.3
81.5 ± 7.2
136 (33.1) 275 (66.9)
88 (21.4) 180 (43.8)
48 (11.7) 95 (23.1)
0.881
271 (65.9) 114 (27.7)
193 (50.0) 64 (16.6)
79 (20.5) 50 (13.0)
0.005
289 (70.3) 122 (29.7)
191 (46.5) 77 (18.7)
98 (23.8) 45 (10.9)
0.563
356 (86.6) 55 (13.4)
228 (55.5) 40 (9.7)
128 (31.1) 15 (3.6)
0.208
245 (59.6) 166 (40.4)
160 (38.9) 108 (26.3)
85 (20.7) 58 (14.1)
0.959
371 (90.3) 40 (9.7)
239 (58.2) 29 (7.1)
132 (32.1) 11 (2.7)
0.308
255 (62.0) 156 (38.0)
187 (45.5) 81 (19.7)
68 (16.5) 75 (18.2)
Geriatr Gerontol Int 2015; 15: 910–917
ORIGINAL ARTICLE: BEHAVIORAL AND SOCIAL SCIENCES
Sense of coherence as a key to improve homebound status among older adults with urinary incontinence Kyo Takahashi,1,2 Atsushi Kato,3 Tomoyuki Igari,4 Eriko Sase,1 Akira Shibanuma,1 Kimiyo Kikuchi,1 Keiko Nanishi,1 Masamine Jimba1 and Junko Yasuoka1 1
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, 2Department of Social Rehabilitation, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, 3Japan Toilet Labo, Tokyo, and 4 Sodegaura Satsukidai Hospital, Chiba, Japan
Aim: Being homebound is regarded as a negative condition for social participation in Japan. However, little is known about the possibility of psychological resilience to prevent being homebound among older adults with urinary incontinence. The present study aimed to examine the association between sense of coherence as a measure of psychological resilience and being homebound among older adults with urinary incontinence. Methods: A cross-sectional study was carried out in Chiba, Japan. We trained 95 care managers as interviewers, and they collected the data from 411 community-dwelling frail older adults using a pretested structured questionnaire. Logistic regression analysis was run to identify factors associated with being homebound among the participants with urinary incontinence. Results: Of the participants, 158 (38.4%) had urinary incontinence. Among the participants with urinary incontinence, 52 (32.9%) were homebound. As a result of logistic regression analysis adjusting for age, sex, living status, hobby, types of prevalent diseases, walking ability, perceived social support and subjective social capital, lower meaningfulness in their lives, which is a component of a sense of coherence, remained positively associated with being homebound (adjusted odds ratio 0.79, 95% confidence interval 0.65–0.96). Conclusions: Being homebound is less prevalent among those who feel challenges, or worthy of investment or engagement in daily life. By improving a sense of meaningfulness, homebound status might be improved among older adults with urinary incontinence. To encourage active social participation of the target population, their psychological resilience (particularly meaningfulness) should be addressed more. Geriatr Gerontol Int 2015; 15: 910–917. Keywords: frail elderly, homebound persons, psychological resilience, sense of coherence, urinary incontinence.
Introduction Japan is one of the most aged countries in the world. In 2012, 23.3% of the total population was aged 65 years or older, the highest in the world.1 To support the quality of daily life of older adults and their family members, the Government of Japan introduced the long-term care insurance (LTCI) system in 2000. The LTCI classifies the users into seven levels based on the amount of support or care required: support levels
Accepted for publication 10 June 2014. Correspondence: Dr Junko Yasuoka DSc MPH, Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Email: [email protected]
910 |
doi: 10.1111/ggi.12353
1–2, and care levels 1–5. For the users, the LTCI offers various community-based care services, such as nursing home visits, day-care services and short-stay services.2 However, as the number of older adults increases, older adults’ issues are moving beyond the biological and becoming increasingly psychosocial.1–4 For example, urinary incontinence, the complaint of involuntary leakage of urine,5 is now prevalent among older adults as a result of the decline of health and negatively affects their social participation.3,6–8 Being homebound is regarded as a negative condition for social participation in Japan, while it has been also investigated in the context of older adults’ frailty in other developed countries, such as the USA.9–11 The Ministry of Health, Labor and Welfare of Japan treats being homebound as a prioritized problem in the preventive care program.12 Although the definition of being © 2014 Japan Geriatrics Society
Sense of coherence and being homebound
homebound varies, the frequency of going outdoors has been commonly used to identify being homebound in Japan.9 Specifically, one who goes outdoors once a week or less often is regarded as a homebound person.13–17 Various factors have been found to be associated with being homebound, such as cardiovascular, cerebrovascular and musculoskeletal disorders.10,11 In particular, walking ability has been treated as an essential factor to be or not to be homebound.13,14,18,19 Two longitudinal studies have identified being homebound itself as a useful predictor of the incidence of physical disability or being bedridden.19,20 However, less attention has been paid to psychological factors that could prevent being homebound. Psychological resilience might have the potential to protect older adults who experience a stressful life event, such as urinary incontinence.21 Resilience is defined as “a dynamic process encompassing positive adaptation within the context of significant adversity” by Luthar et al.22 During the past few decades, many researchers were attracted by this salutogenic concept, and explored psychological resilience factors that could buffer the negative effects of stressful life events.23–26 Although measuring psychological resilience is not easy, sense of coherence (SOC) is gaining more attention as a measure of psychological resilience in public health.27,28 Antonovsky introduced SOC as “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable (comprehensibility); the resources are available to one to meet the demands posed by these stimuli (manageability); and these demands are challenges, worthy of investment and engagement (meaningfulness).”29,30 In other words, the SOC is a specific way of viewing life as comprehensible, manageable and meaningful, and assists in responding to life’s stresses.29,31 Many studies have investigated SOC in relation to quality of life (QOL).32 For example, SOC was found as a promoting factor in QOL in several Scandinavian longitudinal studies that included older adults with lower-limb ischemia and with hip fracture.33–35 Despite a rapid accumulation of SOC studies, the experience of being homebound has not been well investigated, especially among older adults with urinary incontinence. The present study, therefore, aimed to examine the association between SOC and being homebound among community-dwelling older adults, especially those with urinary incontinence. We intentionally selected older adults with urinary incontinence, because their psychological resilience has not been well investigated despite their suffering from urinary incontinence. We hypothesized that high SOC would be inversely associated with being homebound among older adults with urinary incontinence. © 2014 Japan Geriatrics Society
Methods Study design and site A cross-sectional study was carried out from April to August 2012, using a structured questionnaire. The study sites were Futtsu city, Kimitsu city, Kisarazu city and Sodegaura city in Chiba Prefecture, Japan. These four cities are administratively regarded as one Kimitsu region under the jurisdiction of the Kimitsu Health and Welfare Center.36 The Kimitsu region is located approximately 50 km away from Tokyo, and many inhabitants are engaged in agriculture, fishery and heavy industries along the coast of Tokyo Bay. The total population in this region was 330 877, and 78 780 of them (23.8%) were aged 65 years or older on 1 April in 2012.37 Among 90 LTCI-related institutions (community comprehensive support centers, in-home care support offices) in the study site, 35 institutions cooperated with the present study. We trained 95 LTCI specialists (care managers) in these 35 institutions as interviewers to collect the data from their LTCI users.
Participants The participants were community-dwelling older adults who received a service of the LTCI. Inclusion criteria included being aged 65 years or older, living at home, being officially certified as on support level 1 or 2, or care level 1 or 2. We excluded those certified as on care levels 3, 4 and 5, as severe dementia is prevalent among them.38 Furthermore, trained care managers screened their assigned LTCI users for severe dementia, and had previously excluded those with severe dementia from the present study because of their inability to provide informed consent.
Questionnaire We developed a structured, pretested questionnaire. It included the following items: sociodemographics (age, sex, living status, hobby), certified support/care level, types of prevalent diseases (mental and behavioral, musculoskeletal system and connective tissue, genitourinary system), homebound status, walking ability, urinary incontinence, perceived social support, subjective social capital and SOC. Being homebound was defined as a condition with infrequency of going outdoors. Based on previous studies, a cut-off point was set between “once per 2–3 days or more often” and “once a week or less often,” and we regarded the latter as being homebound.13–17 Urinary incontinence, a condition with involuntary leakage of urine once a day or more often, was assessed using an item of the Barthel Index.39 We measured perceived social support and subjective social capital as environmental factors that could affect the | 911
K Takahashi et al.
association between SOC and homebound status. To measure perceived social support, we used the Multidimensional Scale of Perceived Social Support (MSPSS), which was developed by Zimet.40 For subjective social capital, we used the subjective social capital scale developed by Togari.41 The validity and reliability of these two scales were confirmed with various communitydwelling Japanese including older adults.41,42 To measure SOC, we used the SOC scale developed by Antonovsky.29 The SOC scale measures an individual’s orientation to life based on a sense of comprehensibility, manageability and meaningfulness. Yamazaki developed the Japanese version of the SOC scale, and it has been used among older adults in Japan.43,44 Among several versions, we selected the short-version of the SOC scale, which consists of 13 items (5 items for comprehensibility, 4 items for manageability, 4 items for meaningfulness) with five response levels, for its simplicity. A higher score indicates higher SOC. We observed a sufficient internal consistency with a Cronbach’s alpha of 0.83 (comprehensibility 0.72, manageability 0.59 and meaningfulness 0.53). Trained care managers filled in the questionnaires in two instalments. First, they recorded age, sex, living status, certified support/care level and types of prevalent diseases before carrying out the interviews. Second, they showed and read out other questions directly to the study participants, and recorded their verbal responses on the questionnaires. To establish the validity and reliability of the questionnaire, it was revised and pretested by two toileting experts from the Japan Toilet Labo (a non-profit organization), three health administrators from the Kimitsu Health and Welfare Center, and two health professionals and three care managers at the study site.
Data analysis Three types of statistical analyses were carried out. First, descriptive analysis was carried out to provide an overview of the characteristics of the participants. Crude associations were explored between all variables and homebound status using χ2-tests for nominal variables and independent samples t-tests for continuous variables. Second, logistic regression analysis was carried out to identify variables significantly associated with being homebound among all participants. Finally, logistic regression analysis was carried out again only among the participants with urinary incontinence. In the regression models, three components of SOC (comprehensibility, manageability and meaningfulness) were entered separately, as we focused on their different characteristics for profound interpretation and their crude associations with being homebound varied in bivariate analyses. Regarding multicollinearity, we confirmed Pearson correlation coefficients with less than 912 |
0.80 among perceived social support, subjective social capital and three SOC components.45 The computer program PASW statistics 18.0 (SPSS, Chicago, IL, USA) was used for all statistical analyses.
Ethical considerations We obtained ethical approval from the Research Ethics Committee of the Graduate School of Medicine of the University of Tokyo. The following ethical points were considered. We trained care managers who already had rapport with the participants. After explaining the principals of voluntary participation and confidentiality, we obtained written consent from all participants. A family member or trained care manager signed the consent form when a participant could not write his or her own signature because of visual or physical disability. As all participants required support and care, we developed the questionnaire to be as brief as possible to protect them from fatigue.
Results The characteristics of the 411 participants are shown in Table 1. The mean age was 82 years (SD 7.3), and 143 (34.8%) were homebound. Regarding urinary incontinence, 158 (38.4%) were incontinent. Between two groups classified by homebound status (frequency of going outdoors), living alone (P = .005) and being dependent for walking (P < .001) were positively associated with being homebound. Table 2 shows the results of logistic regression analysis predicting being homebound among all participants. Those who were older (AOR 1.04, 95% CI 1.00–1.08), those who lived alone (AOR 3.10, 95% CI 1.81–5.32) and those who were dependent for walking (AOR 3.99, 95% CI 2.35–6.76) were more likely to be homebound. Table 3 shows the results of logistic regression analysis predicting being homebound among participants with urinary incontinence. Those who were dependent for walking (AOR 3.77, 95% CI 1.58–8.98) and those who perceived higher social support (AOR 1.07, 95% CI 1.01–1.12) were more likely to be homebound. In addition, those who had a higher sense of meaningfulness in their lives, a component of SOC, were less likely to be homebound than those having a lower sense of meaningfulness (AOR 0.79, 95% CI 0.65–0.96). However, the other two components of SOC, comprehensibility and manageability, were not significantly associated with being homebound in our logistic regression analysis.
Discussion Being homebound was less prevalent among those who felt higher levels of meaningfulness; that is, they felt © 2014 Japan Geriatrics Society
Sense of coherence and being homebound
Table 1 Participant characteristics classified by homebound status (n = 411) Variables n (%)
Total 411 (100)
Homebound status (frequency of going outdoors) Once per 2–3 days Once a week P-value or more often or less often 268 (65.2) 143 (34.8)
Age† (mean ± SD) Sex Male Female Living status With family Alone Hobby One or more None Mental and behavioral No Yes Musculoskeletal system and connective tissue No Yes Genitourinary system No Yes Walking Independent Dependent Urinary incontinence Continent Incontinent Perceived social support†, mean ± SD Subjective social capital†, mean ± SD Sense of coherence†, mean ± SD Comprehensibility†, mean ± SD Manageability†, mean ± SD Meaningfulness†, mean ± SD
81.9 ± 7.3
81.5 ± 7.2
136 (33.1) 275 (66.9)
88 (21.4) 180 (43.8)
48 (11.7) 95 (23.1)
0.881
271 (65.9) 114 (27.7)
193 (50.0) 64 (16.6)
79 (20.5) 50 (13.0)
0.005
289 (70.3) 122 (29.7)
191 (46.5) 77 (18.7)
98 (23.8) 45 (10.9)
0.563
356 (86.6) 55 (13.4)
228 (55.5) 40 (9.7)
128 (31.1) 15 (3.6)
0.208
245 (59.6) 166 (40.4)
160 (38.9) 108 (26.3)
85 (20.7) 58 (14.1)
0.959
371 (90.3) 40 (9.7)
239 (58.2) 29 (7.1)
132 (32.1) 11 (2.7)
0.308
255 (62.0) 156 (38.0)
187 (45.5) 81 (19.7)
68 (16.5) 75 (18.2)
