Older Adult Males Who Worked at Small-Sized Workplaces Have an Increased Risk of Decline in Instrumental Activities of Daily Living: A Community-Based Prospective Study

BACKGROUND: To examine the relationship of working history from early adulthood through old age with instrumental activities of daily living (IADL). METHODS: Analyzed participants were 5,857 community-dwelling older Japanese people aged ≥65 years. Using the Tokyo Metropolitan Institute of Gerontology Index of Competence, IADL decline was defined as individuals who had no IADL dependence at baseline but were deemed as dependent in IADL at follow-up. Work history was based on working status at baseline, total working years, and information concerning the longest held job, including occupation, employment pattern, and workplace size (number of employees). We conducted multiple logistic regression analyses and estimated the odds ratios (ORs) for IADL decline with 95% confidence intervals (CIs) by gender. RESULTS: At the 33-month follow-up, 428 men (16.6%) and 275 women (8.4%) developed IADL decline. After covariate adjustments, men with unstable employment reported significantly increased IADL decline (OR 1.52; 95% CI, 1.19–1.95) compared to men with stable employment, and men who worked in small workplaces with 1–49 employees had an increased risk for IADL decline (OR 1.53; 95% CI, 1.21–1.93) compared to men in large-sized workplaces with ≥50 employees. After mutual adjustment for all working history items, only the association between small workplaces and IADL decline remained significant in men (OR 1.37; 95% CI, 1.03–1.84). Among women, none of the working history items were associated with IADL decline. CONCLUSION: Our results suggest that not only promoting older people’s workforce participation, but also providing workers employed at small workplaces with sufficient occupational health services, may be effective in helping men retain IADL in later life.