Subjective Well-Being Is Associated with Food Behavior and Demographic Factors in Chronically Ill Older Japanese People Living Alone

Objectives: This study aimed to examine the relationships among subjective well-being, food and health behaviors, socioeconomic factors, and geography in chronically ill older Japanese adults living alone. Design: The design was a cross-sectional, multilevel survey. A questionnaire was distributed by post and self-completed by participants. Setting: The sample was drawn from seven towns and cities across Japan. Participants: A geographic information system was used to select a representative sample of older people living alone based on their proximity to a supermarket. Study recruitment was conducted with municipal assistance. Measurements: To assess subjective well-being and food and health behaviors of respondents with disease, a logistic regression analysis was performed using stepwise variable analyses, adjusted for respondent age, socioeconomic status, and proximity to a supermarket. The dependent variable was good or poor subjective well-being. Results: In total, 2,165 older people (744 men, 1,421 women) completed the questionnaire (63.5% response rate). Data from 737 men and 1,414 women were used in this study. Among people with a chronic disease, individuals with good subjective well-being had significantly higher rates than those with poor subjective well-being for satisfaction with meal quality and chewing ability, food diversity, food intake frequency, perception of shopping ease, having someone to help with food shopping, eating home-produced vegetables, preparing breakfast themselves, eating with other people, and high alcohol consumption. A stepwise logistic analysis showed that the factors strongly related to poor subjective well-being were shopping difficulty (men: odds ratio [OR] = 3.19, 95% confidence interval [CI], 1.94–5.23; P < 0.0001; women: OR = 2.20, 95% CI, 1.54–3.14; P < 0.0001), not having someone to help with food shopping (women: OR = 1.41, 95% CI, 1.01–1.97; P = 0.043), not preparing breakfast (women: OR = 2.36, 95% CI, 1.40–3.98; P = 0.001), and eating together less often (women: OR = 1.99, 95% CI, 1.32–3.00; P = 0.002). Conclusion: Subjective well-being of people with chronic diseases is associated with food intake and food behavior. The factors that affect poor subjective well-being in chronically ill older Japanese people living alone include food accessibility and social communication.