To identify life−related factors causing increased mortality, 2, 769 rural residents aged 29−77 were investigated through a self−administered questionnaire in 1990. Death certificates and migration information were inspected during the 4.5−year follow−up period. Age, obesity, life attitude, job, marital status, drinking and smoking habits, previous or current illness, and frequency of participation in health examinations were checked during the baseline survey. The person−year mortality rate was higher among irregular participants in health examinations than among regular participants both among males and females. From Cox’s multiple regression analysis, factors with a significantly high hazard ratio (HR) for mortality were irregular participation (HR=2.05), increase of age (HR=1.54, for 10 years), previous or current illness (HR=2.44), unemployment (HR=1.95), and living without a spouse (HR=2.61) for males; and for females they were having previous or current illness (HR=15.21) and living without a spouse (HR=2.94). Thus, irregular participation in health examinations, unemployment and aging showed a relationship with a higher mortality only in males. A previous or current illness and living without a spouse were related in both sexes.
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OBJECTIVESThere is a growing need to evaluate the performance status of the activities of daily living (ADL) of the elderly in the rapidly aging Japanese society. The purpose of this study was to verify the usefulness of our new scoring sheet for assessing present ADL status and to clarify whether or not the assessed ADL status can predict the future risk of adverse conditions related to falls.

METHODSThe validation study was performed using 116 non-handicapped community-dwelling Japanese elderly at least 60 years of age. Of those subjects, 44 were also analyzed for the relationship between baseline ADL status and subsequent risk of adverse conditions related to falls.

RESULTSThe daily living performance score sheet had good internal consistency, with a Cronbach's alpha of 0.82 and a sequential hierarchical structure that reflected the difficulty of the activities. The total score was significantly and positively associated with six of eight subscale scores on the Short-Form 36-Item Health Survey (P < 0.01). In the follow-up study, every one-point decrease in total score was significantly associated with a 39% elevated risk of a stumble or fall (P = 0.022) and also borderline significantly associated with higher risks of a fall, anxiety while walking indoors, and anxiety while walking outdoors (P < 0.10).

CONCLUSIONOur new scoring sheet can reliably and comprehensively assess present ADL status. The assessed ADL could predict the future risk of adverse conditions related to falls.