JMIR Publications

ABSTRACT

Background:

Higher-Level Functional Capacity (HLFC) is important for independent living among older adults. Internet use has a positive impact on older adults’ health, but its impact on HLFC and the difference in this impact based on educational attainment is unclear.

Objective:

This longitudinal study aimed to examine whether Internet use can suppress the risk of decline in HLFC and whether this effect could be obtained even for older adults with low educational levels.

Methods:

Data were obtained from the Japan Gerontological Evaluation Study (JAGES), which included 8,050 community-dwelling adults aged ≥65 years from 2016 to 2019. To focus on older adults who maintained independence from 2016 to 2019, the final participants in this analysis were older adults with independent HLFC in 2016. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to operationally define and HLFC, which consists of three subscales: instrumental activities of daily living (IADL), intellectual activity, and social role. The independent variable was defined as the frequency of Internet use in 2016; those who used the Internet more than once a month were categorized as Internet users, and the others were categorized as Internet non-users. The suppression effects of Internet use on HLFC decline were compared by stratified educational attainments of ≤9 years, 10–12 years, and ≥13 years. Poisson regression analysis corrected for robust standard error was used for statistical analysis to calculate the risk ratio (RR) and 95% confidence interval (CI) for HLFC decline in 2019.

Results:

Adjusted for demographic and health condition risk factors, Internet use was significantly associated with suppressing the declining risk in HLFC of older adults after three years, even for those with low education. Internet users with ≤9 years of educational attainment had a suppression of decline in the total score (RR[CI] 0.57 [0.43–0.76]), IADL (0.58 [0.38–0.91]), intellectual activity (0.60 [0.41–0.89]), and social role (0.74 [0.56–0.97]) compared to non-users. Similarly, those with 10–12 years had (0.78 [0.63–0.98]), (0.59 [0.39–0.90]), (0.91 [0.63–1.31]), (0.82 [0.68–0.9998]) respectively, and those with ≥13 years had (0.65 [0.51–0.85]), (0.55 [0.36–0.83]), (0.64 [0.37–1.10]), and (0.83 [0.64–1.08]) respectively.

Conclusions:

The study suggests that Internet use can help maintain independence of HLFC not only among older adults with high education but also among those with low education. Future policies promoting Internet utilization among older adults with low education will contribute to the reduction of functional health disparities due to educational attainment.