COMPLETION REPORT
A Cross-Cultural Comparison on Functional Decline in Community-dwelling Older Adults between
Thailand and Japan
Dr. Kwanchit Sasiwongsaroj(+7)
Assistant Professor
Research Institute for Languages and Cultures of Asia,
Mahidol University

Background: Functional dependence is associated with increased reliance on supportive community services,
hospital admissions, medical costs, and lower quality of life. Older adults in developed countries are more likely
to be disability-free than those in developing countries. Preventing or delaying the onset of disability in olderadults would yield positive impacts on an individual’s quality of life, as well as economic benefits for society as awhole. This is particularly the case in developing countries where institutional welfare is somewhat unreliable
and has a relatively short period of time to prepare for an aging society.
Objectives: The objective of this study was to examine functional decline over a 2-year follow-up period andfactors associated with functional decline among older adults in two countries at vastly different stages ofdemographic transitions and economic development, Thailand and Japan.
Methods: The research involved a two-year longitudinal study of Thai and Japanese community-dwelling
adults aged 65 and older. A questionnaire with standardized measurement of basic activities of daily living(ADL), sociodemographic information, chronic diseases, body mass index, depression, and social activities wasused to assess Thai elderly in Nakhon Pathom (Thailand) and Japanese elderly in Tosa Town (Kochi Prefecture,Japan) annually on three occasions. From 338 Thai and 869 Japanese participants who had no functional
limitations at baseline, a total of 216 Thai and 480 Japanese participants completed the study. Function loss was
defined as a below full score of 21 on basic ADL. Bivariate and multivariate analyses using logistic regression
models were conducted to identify factors associated with functional loss.
Results: In the 2 years of follow-up, the Thai participants reported a higher percentage of functional decline thanthe Japanese participants (22.2% vs 13.5%; P <.05). Risk factors associated with functional decline in the elderly
Thais included increased age (odds ratio (OR) = 1.16, 95% CI 1.06-1.25), female gender (OR = 0.32, 95% CI
0.13-0.79), low economic satisfaction (OR = 2.45, 95% CI 1.13-5.30), and low social activity (OR = 3.69, 95%
CI 1.45-9.39). Functional decline in the Japanese elderly was associated with increased age (OR = 1.10, 95% CI
1.02-1.18), low social activity (OR = 3.39, 95% CI 1.30-8.30), and arthropathy (OR = 2.45, 95% CI 1.07-5.64).

1/6

Conclusion: During the study period, the Thai elderly were more likely to increase the number of function
limitation than their Japanese counterparts. This study underlines that no chronic diseases were associated withan increased risk of functional decline in either groups. Only arthropathy was associated with functional decline
in Japanese elderly. Social activity, on the other hand, was a very strong predictor of functional decline for bothThai and Japanese elderly. Our results support the promotion of social activities for older persons in order topreserve their healthy functional status.

Publication of the Results of Research Project:
Verbal Presentation (Date, Venue, Name of Conference, Title of Presentation, Presenter, etc.)
I plan to present my research results next year (2017) and will report to Sumitomo Foundation.

Thesis (Name of Journal and its Date, Title and Author of Thesis, etc.)
I am writing a research article to publish in a journal, but I have not yet finished it. My published paper will be
notify to Somitomo Foundation.
Book (Publisher and Date of the Book, Title and Author of the Book, etc.)

2/6

Appendix

Nakhon Pathom, Thailand

Tosa Town, Japan

1st interview (T1)
Participants aged 65 and overn = 338
2014

2013

Screening subjects with
ADL score =21

ADL< 21n = 86

2016

1st interview (T1)
Participants aged 65 and overn = 869

No functional
limitation at thebaselinen = 252

No functional
limitation at thebaselinen = 631

ADL< 21n = 238

Participated in T2

Drop outn = 36

Drop outn = 151n = 216n = 480

ADL after 2 years(ADL< 21)

Declinedn = 48(22.2%)

Not declined
n = 168(77.8%)

Declinedn = 65(13.5%)

3/6

Not declined
n = 145(86.5%)

2015

Table 1 Baseline characteristics (2014) of community- dwelling elderly aged 65 years who were healthy at the baseline(ADL =21) in Thailand (2014) and Japan (2013)
Nakhon Pathom city

Tosa town

Thailand (n = 216)

Japan (n = 480)

Age (mean ± SD)

72.29 (5.64)

74.64 (6.72)<0.001

Female gender (%)
Year of education (mean ± SD)

67.10

56.50

0.008

8.64 (3.59)

10.00 (2.04)<0.001

Living alone (%)

7.40

17.30

0.001

Subjective economic satisfaction (100)67.27 (18.70)
53.3

59.21 (23.69)
48.8<0.001
0.280

22.70

11.80

<0.001Hypertension

50.90

56.00

0.031

Heart disease

8.80

13.90

0.014

Cerebrovascular disease

1.90

5.40

0.009

Arthropathy
Obesity (BMI ≥ 25 Kg/m2)

14.90

33.70

35.3

25.7

<0.0010.012

GDS (15)

2.70 (2.09)

3.20 (3.12)

0.020

9.70
39.8

21.50
48.0

<0.001

Low economic satisfaction (below mean score) (%)
Chronic disease (%)
Diabetes

GDS ≥ 6 (%)
Low social activity (below full score of 4) (%)

SD, standard deviation; BMI, Body Mass Index; GDS, Geriatric Depression Scale-15 items

4/6

p- value

0.046

Table 2 Association between hypothesized covariates and BADL decline: Univariate analysis
Predictors

NP, Thailand (n = 216)
OR (95% CI)

Tosa, Japan Japan (n = 480)

p- valueOR (95% CI)

p- valueAge

1.13 (1.06- 1.20)

0.000

1.11 (1.07-1.16)<0.001

Female gender

0.46 (0.22- 0.99)

0.047

0.79 (0.46-1.34)

0.375

Year of education

0.90 (0.82- 0.99)

0.035

0.76 (0.65-0.89)

0.001

Living alone

1.66 (0.55- 5.03)

0.371

1.87 (0.99-3.50)

0.452

Low economic satisfaction

2.56 (1.25- 5.02)

0.010

1.42 (0.83- 2.44)

0.199

Diabetes

1.02 (0.47 - 2.18)

0.965

1.31 (0.62-2.83)

0.490

Hypertension

1.32 (0.69- 2.51)

0.404

1.72 (0.98- 2.98)

0.059

Heart disease

1.08 (0.34 - 3.42)

0.898

1.89 (0.97- 3.65)

0.060

Cerebrovascular disease

1.17 (0.12- 1.51)

0.893

1.53 (0.56- 4.22)

0.408

Arthropathy

1.19 (0.50- 2.86)

0.694

2.67 (1.56- 4.58)<0.001

Obesity

1.43 (0.71- 2.88)

0.311

1.84 (0.83- 4.08)

0.132

GDS ≥ 6

1.24 (0.40- 3.81)

0.713

3.80 (1.94- 7.44)<0.001

Low social activity

2.75 (01.25- 6.05)

0.012

3.011 (1.67- 5.46)<0.001Chronic disease

GDS, Geriatric Depression Scale-15 items

5/6

Table 4 Predictors of ADL decline: Multiple Logistic Regression
Variables

NP, Thailand (n= 216)

Tosa, Japan (n= 480)

OR (95% CI)

OR (95% CI)

age

1.16 (1.09- 1.24)***

1.11 (1.06- 1.16)***

Female gender

0.25 (0.11- 0.62)**

0.69 (0.39- 1.23)

Low social daily activity

3.77 (1.56- 9.07)**3.13 (1.67- 5.86)***age

1.16 (1.07- 1.24)***1.10 (1.04- 1.16)**

Female gender

0.30 (0.12- 0.76)*

0.82 (0.42- 1.59)

Year of education0.96 (0.87- 1.07)

0.89 (0.76- 1.06)

Low economic satisfaction

2.37 (1.10- 5.10)*

1.70 (0.87- 3.32)

Low social daily activity

3.56 (1.43- 8.90)**

2.97 (1.41- 6.26)**

age

1.16 (1.06- 1.25)***1.10 (1.02- 1.18)*

Female gender

0.32 (0.13- 0.79)*

0.86 (0.37- 2.01)

Year of education

0.96 (0.86- 1.08)

0.93 (0.75- 1.15)

Low economic satisfaction

2.45 (1.13- 5.30)*

1.42 (0.59- 3.45)

Low social activity

3.69 (1.45- 9.39)**

3.39 (1.30- 8.30)**

Arthropathy

1.64 (0.59- 4.57)

2.45 (1.07- 5.64)*

GDS ≥ 61.50 (0.41- 5.57)

2.18 (0.88- 5.39)

Model 1Model 2Model 3

GDS, Geriatric Depression Scale-15 items

6/6