Objectives　This study aimed to develop the Family Empowerment Scale for Parents with Toddlers (FES-P) and to examine its validity and reliability.

Methods　A draft version of the scale was prepared based on a literature review and interviews with experts. Next, we conducted a web-based structured questionnaire survey of 800 parents (400 men and 400 women) with children aged 1 to 3 years, across Japan, and then verified the validity and reliability of the FES-P. The repeatability and stability by the retest method were examined as well.

Results　We analyzed the data of the 825 individuals (412 men and 413 women) who answered the survey. Exploratory and confirmatory factor analyses revealed that the optimum solution that can interpret each factor could be obtained with five sub-factors and 26 question items. We confirmed that the five sub-factors were “relationships within the family,” “sense of efficacy with regard to parenting,” “relationships with the community,” “sense of achievement as a parent,” and “recognition and combined use of services.” Good-fit values were obtained, with GFI=.878, AGFI=.852, CFI=.943, and RMSEA=.044, and construct validity was confirmed. The Cronbach's alpha coefficient was .96 for the entire scale and .85 to .92 for the sub-factors; the scale was deemed to have sufficient internal consistency. Further, the total score of the FES-P was positively correlated with the Family APGER score (r=.562, P<.001), scale measuring feelings about parenting (r=.620, P<.001), and generalized self-efficacy scale (r=.318, P<.001). For test-retest reliability, the intra-class correlation coefficient was r=.876 for the entire scale and r=.794 to .876 for the sub-factors, indicating stability and reproducibility.

Conclusion　This study developed the FES-P, consisting of five sub-factors and 26 items and showing good validity and reliability. The five sub-factors were cross-correlated constructs. “Sense of efficacy with regard to parenting” and “sense of achievement as a parent” consisted of items related to individual empowerment, “relationships within the family” and “relationships with the community” consisted of items related to relationships with others, and “recognition and combined use of services” consisted of items related to social resources.

Objectives　This study aimed to determine risk factors for frailty and lifestyle-related diseases impacting the incidence of loss of independence among Japanese community-dwelling older adults, and to measure the magnitude of these associations.

Methods　We conducted an 8.1-year prospective study involving 1,214 residents of the town of Kusatsu, aged 65 years and over, who were initially free of disability and underwent the comprehensive geriatric assessment between 2002 and 2011. Loss of independence was defined as the incidence of disability or having died before the occurrence of disability was certified by the Long-Term Care Insurance program in Japan. Risk factors for lifestyle-related diseases and health status comprised hypertension, diabetes mellitus, overweight, chronic kidney disease, current smoking, past history of stroke, heart disease and cancer, frailty, underweight, anemia, hypoalbuminemia, and cognitive decline. Frailty was defined as the presence of three or more of the following criteria: Weight loss, weakness, exhaustion, slowness, and low levels of physical activity. Prefrailty was defined as the presence of one or two of these same criteria. Cox proportional-hazard regression model was used to estimate hazard ratios (HR) and the population attributable fraction (PAF) of loss of independence.

Results　During the follow-up, 475 cases, including 372 disabilities and 103 deaths, were identified as having experienced loss of independence. The multivariable HRs for the loss of independence were 1.3 to 2.2-fold higher for the presence of frailty, past history of stroke, cognitive decline, prefrailty, and smoking. The PAF of loss of independence was the greatest for prefrailty (19%), followed by frailty (12%). The PAF was relatively large for prefrailty (19%) and smoking (11%) in men, and frailty (18%), prefrailty (18%), and chronic kidney disease (11%) in women. Stratified by age category, participants aged 65-74 years having frailty and several lifestyle-related diseases showed significantly higher HRs for loss of independence and greater PAFs for prefrailty (18%), frailty (13%), and smoking (11%).

Conclusions　Loss of independence among Japanese community-dwelling older adults who underwent screening examinations was largely attributed to frailty and prefrailty. Our findings suggest that the screening and the intervention for frailty and lifestyle-related diseases in the early stages of old age might be beneficial in prolonging healthy life expectancy of Japanese community-dwelling older adults.