Everyday challenges facing high-risk older people living in the community: a community-based participatory study

Abstract

Background: Considering the real-world experiences of those with cognitive impairments is important in building a positive community for older people. Community-based participatory research is an important methodology for investigators focused on improving community health. The aim of this study was to 1) investigate factors associated with the continuation of community dwelling among high-risk older people and 2) to create a model of an inclusive community space for older people in the largest housing complex district in Tokyo. Methods: From 198 residents who completed all three steps (mail, face-to-face, and home-visit) of a previous largescale epidemiological survey, we identified 66 residents who were at high-risk of moving out of the community. These participants underwent 6 months of regular assessments by experienced researchers to identify the factors associated with continuing to live in the community. We also employed a community action approach to develop a community space for residents in the study district where more than two researchers who were medical professionals served as staff. The services offered by the space were continuously improved according to user feedback. The function of this center was evaluated during interdisciplinary research meetings. Results: After 6 months, among the 66 high-risk residents, 49 people were living in the community and 12 people had moved out of the community. Those who could not continue to live in the community had greater unmet needs in terms of social support, especially daily living support and housing support. In addition, their families perceived a heavier burden of care. Interestingly, dementia diagnosis via the DSM-5, clinical dementia rating, physical health, mental health, and long-term care usage did not predict the outcome. Through discussions with guests, we equipped the space with various services such as coordination of community care and networking with existing organizations. Conclusions: Merely providing healthcare and long-term care might not be sufficient to support community living in people with cognitive impairments. Daily living support and housing support should be provided in the context of a broad health services package. For this purpose, creating a comfortable community space for residents and community workers is essential.

Living on the edge of the community: factors associated with discontinuation of community living among people with cognitive impairment

“…To overcome these limitations, we used a community-based participatory research (CBPR) framework [ 15 ]. In addition to using conventional mailing and telephone contact to re-access residents, we created a base camp for our research that provided a comfortable place for community residents to spend time, and in which researchers and community workers could collaborate with community residents.…”

“…There is a research gap concerning the experiences of people with cognitive impairment and protective factors to help this vulnerable population to maintain community living. We identified 198 people who scored < 24 on the MMSE in a baseline survey conducted in 2016 that included all community-dwelling people aged 70 years or over in one Tokyo district [ 14 , 15 ]. The present study aimed to 1) re-access individuals with cognitive impairment from that cohort and explore their current situation; and 2) identify factors associated with all-cause discontinuation of community living.…”

Living on the Edge of the Community: Factors Associated with Discontinuation of Community Living Among People with Cognitive Impairment

“…To overcome these limitations, we used a community-based participatory research (CBPR) framework. 9 In addition to using conventional mailing and telephone contact to re-access residents, we created a base camp for our research that provided a comfortable place for community residents to spend time, and in which researchers and community workers could collaborate with community residents. Although this center welcomed all residents regardless of age or address, participants from the original study were repeatedly informed about the center.…”

“…We identi ed 198 people who scored < 24 on the MMSE in a baseline survey conducted in 2016 that included all community-dwelling people aged 70 years or over in one Tokyo district. 8,9 The present study aimed to 1) re-access individuals with cognitive impairment from that cohort and explore their current situation;…”

Defending community living for frail older people during the COVID‐19 pandemic

“…We are developing a realistic method to build an inclusive community for frail older people in a large housing complex district in Tokyo, in which many socially isolated older people live by themselves. 1,2 However, the COVID-19 pandemic has cast a shadow on our research.…”