Marital status and risk of physical frailty: A systematic review and meta-analysis

Objectives: Evidence on associations between marital status and frailty is limited. The objectives of this study were to perform a systematic review for associations between marital status and physical frailty and to perform a meta-analysis to combine findings. Design: Systematic review and meta-analysis. Setting and participants: Community-dwelling older people with mean age ≥60 years. Methods: Systematic literature search using 5 databases was conducted in February 2019 to identify longitudinal and cross-sectional studies examining associations between marital status and Fried's phenotype-based frailty status. Additional studies were searched for by reviewing the reference lists of relevant articles and conducting forward citation tracking of included articles. Odds ratio (OR) of marital status and frailty was pooled using a random-effects meta-analysis. Subgroup analysis and analyses stratified by gender and marital status (married, widowed, divorced or separated, and never married) were completed. Results: A total of 1565 studies were found, from which 3 studies with longitudinal data and 35 studies with cross-sectional data were included. Although longitudinal studies suggested that married men had lower frailty risks than unmarried men while married women had higher frailty risks than widowed women, meta-analysis was not possible because of different methodologies. Meta-analyses of cross-sectional data from 35 studies including 80,754 individuals showed that unmarried individuals were almost twice more likely to be frail than married individuals (pooled odds ratio = 1.88, 95% confidence interval = 1.70-2.07). A high degree of heterogeneity was observed (I2 = 69%) and was partially explained by reasons for not being married and study location. Stratified analyses showed that pooled risks of frailty in the unmarried compared with the married were not statistically different between women and women (P for difference = .62). Conclusions and Implications: Three and 35 studies, respectively, were found providing longitudinal and cross-sectional data regarding associations between marital status and frailty among community-dwelling older people. A meta-analysis of cross-sectional data showed almost twice higher frailty risk in unmarried individuals compared with married individuals. Marital status should be recognized as an important factor, and more longitudinal studies controlling for potential confounding factors are needed

Gender differences in the use of transportation services to community rehabilitation programs

<p>Abstract</p> <p>Background</p> <p>Prevention and reduction of disability among community-dwelling older adults have been an important health policy concern in Japan. Moreover, it has also become a gendered issue due to the recent rapid growth in older females than males with disability living in their own homes. The aim of this study is to examine whether there is a gender difference in the use of community rehabilitation programs in Japan, and if so, whether the lack of transportation services and accompanying caregivers are the reasons for the gender difference.</p> <p>Methods</p> <p>This study was based on surveys of the program administrators and the primary caregivers of the program participants from 55 randomly selected community rehabilitation programs (CRP) in the Tokyo metropolitan area. Questions included sociodemographic characteristics of program participants, types of transportation services provided by the CRP, caregiver's relationship to participant, and the nature of family support. Bivariate statistical analysis was conducted.</p> <p>Results</p> <p>Although there were more females than males with disability residing in communities, our findings showed that females were less likely to use CRP than males (1.3% and 2.3%, respectively; <it>X</it>²= 93.0, p < 0.0001). Lower CRP use by females was related to lower availability of transportation services (36% without transportation service and 46% door-to-door services) and fewer caregivers accompanying the participants to CRP.</p> <p>Conclusion</p> <p>This study builds on previous research findings, which suggest gender inequality in access to CRP.</p

Relation Between Mental Health Status and Psychosocial Stressors Among Pregnant and Puerperium Women in Japan - From the Perspective of Working Status-

Background Mental health problems during pregnancy and postpartum periods are one of the alarming health issues among women in Japan. Many studies have reported that psychosocial risk factors could be correlated with maternal mental health status. Although increased numbers of women who are employed during the pregnancy and postpartum periods have been observed, it is unclear about the link between mental health and psychosocial stressors in terms of working status during pregnancy and postpartum periods. Therefore, this study examined difference in mental health status and the association between mental health and psychosocial stressors by working status amongpregnant and puerperium women, using nationally representative data in Japan. Methods This study analyzed data on the Japanese version of the Kessler 6 (K6), specific psychosocial stressors, and working status of pregnant and puerperium women (n=1126) from respondents in the Comprehensive Survey of Peoples Living Conditions (CSPLC) conducted in 2007 by Ministry of Health, Labour and Welfare in Japan.. The univariate logistic regression analysis and a forward multiple regression analysis were used to examine K6 and related factors including specific psychosocial stressors for working status (employedand unemployed).Results Those who scored five or higher in K6 accounted for 33.2% of 1126 respondents, and mental health had no significant association with working status among pregnant and puerperium women. Multiple logistic analyses showed the significant associations between mental health and psychosocial stressors: family relationship, pregnancy and birth, andincomes/ family budgets/ debts,regardless of employed or unemployed. After stratified by working status, whereas ones job stressor had an association with mental health only for employed females, stressors forones disease/long -term care and housework had associations only for unemployed ones. For employed women, the primary factor for mental health wasfamily relationship stressor. Conclusion Although mental health status measured by K6 was not different between employed or unemployed female population, primary stressors related mental health was revealed to differ with working status. Especially, family relationship stressor was the highest risk factor of mental health in employed women. More importantly, the results provided evidence on the differences in associations between mental health and specific psychosocial stressors by working status. Psychosocial risk assessments and interventions on working status among pregnant and puerperium women should be imperative to pay attention for social politics