Analysis of Changes in Elderly People's Levels of Long-Term Care Needs and Related Factors With a Focus on Care Levels II and III (original) (raw)
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International Journal of Nursing Studies, 2021
Background: Little is known about the association between advanced care management and patient outcomes in home settings. In 2009, the Japanese government introduced a financial incentive scheme for advanced care management by long-term care agencies with at least one advanced care manager. However, it remains unclear whether advanced care management in rural areas is associated with improved outcomes for recipients. Objective: To compare the progression of care-need levels among long-term care recipients in home settings with and without advanced care management. Design: A population-based observational study. Setting: A rural municipality in Japan. Participants: Recipients of long-term care (n = 2005). Methods: We used individual-level secondary data provided from a rural municipal government that was collected as part of the Survey of Long-Term Care Benefit Expenditures and medical care claim records between April 2012 and March 2017. We linked these two databases using unique identifiers. The inclusion criteria for study subjects were that they: (1) were aged ≥65 years; (2) were newly certified as care-need level 1, 2, or 3; and (3) used long-term care insurance services in home settings from April 2012 through March 2017. We excluded individuals using long-term care insurance services for less than six months. Ultimately, we selected 1722 propensity-matched recipients with and without advanced care management, and then conducted Kaplan-Meier survival analyses and a log-rank test. The outcome measure was progression of care-need levels. Results: The proportions of five-year cumulati ve progression-free survival in the groups with and without advanced care management were 50.3% and 42.2% for recipients of care-need level 1 (p < .01), 34.3% and 32.3% for recipients of care-need level 2 (p < .01), and 22.3% and 24.5% for recipients of care-need level 3 (p > .05), respectively. The progression-free period lasted a median of 12 (interquartile range, 10-24) months for recipients of care-need level 1, 14 (interquartile range, 11-28) months for recipients of care-need level 2, and 12 (interquartile range, 10-24) months for recipients of care-need level 3. Conclusions: Long-term care recipients with advanced care management in home settings had a higher probability of progression of care-need levels in a rural municipality of Japan. This finding suggests that the governmental policy of providing financial incentive for advanced care management may not be effective in improving the outcome of long-term care recipients in a rural municipality of Japan.
BMJ Open, 2021
ObjectivesWe compared the care services use and medical institutional deaths among older adults across four home care facility types.DesignThis was a retrospective cohort study.SettingWe used administrative claims data from April 2014 to March 2017.ParticipantsWe included 18 347 residents of Fukuoka Prefecture, Japan, who received home care during the period, and aged ≥75 years with certified care needs of at least level 3. Participants were categorised based on home care facility use (ie, general clinics, Home Care Support Clinics/Hospitals (HCSCs), enhanced HCSCs with beds and enhanced HCSCs without beds).Primary and secondary outcome measuresWe used generalised linear models (GLMs) to estimate care utilisation and the incidence of medical institutional death, as well as the potential influence of sex, age, care needs level and Charlson comorbidity index as risk factors.ResultsThe results of GLMs showed the inpatient days were 54.3, 69.9, 64.7 and 75.0 for users of enhanced HCSCs ...
medRxiv, 2020
Objective We compared the use of various care services and institutional deaths in older adults among these facility types. Design This was a retrospective cohort study. Methods We used administrative claim data from April 2014 to March 2017. The study participants comprised Fukuoka Prefecture residents aged 75 and older with certified care needs of level 3 or more in April 2014 and who received home care services during the study period. Participants were divided into 4 groups according to the facility type from which they received home care services: General Clinics, Home Care Support Clinics and hospitals (HCSCs), Enhanced HCSCs with beds and Enhanced HCSCs without beds. The outcomes were utilization of medical and long-term care services and the incidence of institutional deaths. We constructed generalized linear regression models. The evaluated potential risk factors were sex, age, care needs levels, and Charlson comorbidity index (CCI) scores. Results The numbers of inpatient ...
Long-term care is increasingly concentrated in the last years of life: a change from 2000 to 2011
European journal of public health, 2017
The use of long-term care (LTC) is common in very old age and in the last years of life. It is not known how the use pattern is changing as death is being postponed to increasingly old age. The aim is to analyze the association between the use of LTC and approaching death among old people and the change in this association from 2000 to 2011. The data were derived from national registers. The study population consists of 315 458 case-control pairs. Cases (decedents) were those who died between 2000 and 2011 at the age of 70 years or over in Finland. The matched controls (survivors) lived at least 2 years longer. Use of LTC was studied for the last 730 days for decedents and for the same calendar days for survivors. Conditional logistic regression analyses were performed to test the association of LTC use with decedent status and year. The difference in LTC use between decedents and survivors was smallest among the oldest (OR 9.91 among youngest, 4.96 among oldest). The difference wid...
Changing social burden of Japan’s three major diseases including Long-term Care due to aging
Public Administration and Policy
PurposeThe purpose of this article is to clarify the social burden of Japan’s three major diseases including Long-term Care (LTC) burden.Design/methodology/approachA modification of the Cost of Illness (COI)—the Comprehensive-COI (C-COI) was utilized to estimate three major diseases: cancer, heart disease, and cerebrovascular diseases (CVD). The C-COI consists of five parts: medical direct cost, morbidity cost, mortality cost, formal LTC cost and informal LTC cost. The latter was calculated by two approaches: opportunity cost approach (OC) and replacement approach (RA), which assumed that informal caregivers were substituted by paid caregivers.FindingsThe C-COI of cancer, heart disease and CVD in 2017 amounted to 10.5 trillion JPY, 5.2 trillion JPY, and 6.7 trillion JPY, respectively (110 JPY= 1 US$). The mortality cost was preponderant for cancer (61 percent) and heart disease (47.9 percent); while the informal LTC cost was preponderant for CVD (27.5 percent). The informal LTC cost...
Geriatrics & Gerontology International, 2019
To clarify factors associated with changes in care needs level and mortality among disabled older people receiving home medical care over a period of 2.5 years. Methods: The study included 179 participants, aged ≥65 years, receiving home medical care, who consented to join the Osaka Home Care Registry study. The main outcome was changes in the care needs level of participants eligible for the long-term care insurance system. We investigated the association of changes in care needs level with basic characteristics and care-receiving status. Results: At the 2.5-year follow up, 20.0% of participants showed deteriorated levels, and 41.8% of participants died. In multiple logistic regression, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.00-1.21; P = 0.051) and bone joint diseases (OR 0.34, CI 0.09-1.22; P = 0.098) were possible risks associated with deterioration of the care needs level. Male sex (OR 3.28, CI 0.91-11.74; P = 0.068) was a possible risk factor for mortality, and lower serum albumin (OR 0.22, CI 0.07-0.73) was a significant risk factor for mortality. Conclusions: We clarified the different factors associated with deterioration of the care needs level and mortality among disabled older people. Old age and bone joint diseases might be predictive factors for the further deterioration of independence of physical activity, and a low serum albumin level is considered to be strongly associated with increased mortality.
Country diagnostic study on long term care in Thailand
Asian Development Bank, 2020
Thailand has made more progress than most LMICs in the region on LTC. A key strength of the Thai approach to LTC system development is the investment in and use of research and evidence to inform policy and program design. Secondly, the national definition of LTC and the emphasis on ageing in place has helped to guide the step-by-step approach towards LTC system coverage by starting with developing and expanding home- and community-based care (HCBC) support. Nevertheless, there are many challenges to overcome as Thailand works towards a comprehensive, quality, integrated LTC system which ensures that the care needs of its population are met. There is an urgent need to clarify responsibilities for coordination and authority between key government agencies and between central and local authorities. Registration, regulation, national care standards and accompanying legislation need to be developed and implemented in order to progress towards the quality management of public and private care provision alike. Care workforce shortages are a serious concern and a long-term workforce plan is needed to ensure that sufficient human resources are generated to meet the growing demand for care. Financing LTC will continue to be a challenge for Thailand and an LTC insurance system is likely to be needed. Expanding the HCBC pilot program will require a re-examination of the program’s financing. The program is currently financed through general revenue and is only available to 70% of the population covered by the UCS, without any option for others to buy the services. Local taxes or tax transfers may also be required to finance the social support elements of LTC while the UCS expands to include health-related LTC services. Financing for institutional LTC is not on the policy agenda and the government does not intend to establish public LTC residential homes. Instead, it is focused on developing privately owned, age-friendly housing for active older people. Public support is available for vulnerable groups, but despite the growing need, institutional care support within these residential homes is not planned for or regulated. Private providers of residential LTC homes may be increasingly regulated to higher standards, which should improve the quality of care, but will also increase the cost of the private LTC services. This lack of care provision for those with severe care support needs is an important element to consider in planning. It is important that all parties should work to provide person-centered care and to support older people to attain the best possible quality of life, at home with the family, through community support, or when necessary, in residential care.
European Journal of Ageing, 2017
Long-term care (LTC) use increases with ageing due to an age-related increase in disability. Both the levels of disability and social resources vary among socioeconomic groups. The association of socioeconomic status with LTC use is largely unexplored for the oldest old. This study examined how occupational class is associated with LTC use among nonagenarians in the context of universal care coverage. A population-based prospective cohort study with 2,862 participants who answered the Vitality 90+ Study surveys in 2001, 2003, 2007, or 2010 in Tampere, Finland, was combined with national register data on LTC use. LTC use in total and separately for publicly and privately provided LTC facilities was assessed in a cross-sectional setting and during the 34-month follow-up by using logistic regression and competing-risks regression methods. Functional status, multimorbidity, family relations, and help at home were controlled. In total or public LTC use, only a few differences between occupational classes were found at baseline. However, upper non-manuals used more private LTC than lower non-manuals (OR 0.54, 95% CI 0.35-0.85), skilled manuals (OR 0.40, 95% CI 0.26-0.62) or housewives (OR 0.40, 95% CI 0.22-0.74). There were no statistically significant differences in entering any kind of LTC after adjustments for all independent variables. During the study period, the share of privately provided care out of all LTC increased and the upper non-manuals no more used private care more than other groups. This study underlines the importance of following the structural changes in LTC provision to guarantee that the need for LTC is met equally for all socioeconomic groups.
International Journal for Quality in Health Care, 2018
Objective: To analyze the chronological change in social burden of dementia in Japan for policy implications of appropriate resource allocation and quality improvement. Design: National, population-based, observational study from 2002 to 2014. Setting: Seven nationwide data sets from Japanese official statistics. Method: Comprehensive Cost of Illness method. Main outcome measures: The outcome variables included healthcare services, nursing care services, informal care (unpaid care offered by family and relatives), mortality cost and morbidity cost. Results: The number of patients with dementia increased 2.50 times from 0.42 million in 2002 to 1.05 million in 2014. While the number of patients living in homes and communities increased by 3.22 times that of patients living in nursing care facilities increased by 1.42 times. The total social burden increased 2.06-2.27 times from JPY 1.84-2.42 to 3.79-5.51 trillion (JPY 1 trillion = US$ 100 billion). Regarding the total burden, the proportion of informal care provided increased from 36.6-51.9% to 37.7-57.2%. Furthermore, the proportion of primary caretakers aged ≥70 years increased from 27.6% to 37.6%. Conclusions: Owing to the promotion of 'Deinstitutionalization' (shift of nursing care site from infacilities to in-home and in-community), 'Elderly care by the elderly,' and 'Earlier diagnosis of dementia,' the average cost per patient reduced by 0.82-0.91 times from JPY 4.37-5.77 to 3.60-5.24 million. Therefore, the management of informal care in a manner that does not exceed the acceptable limit of the patients' caretakers, while maintaining patient safety and quality of care, is imperative.
PLOS ONE, 2022
Background In 2006, Japan introduced the Revised Medical Care Act aimed to shift end-of-life care from hospitals to communities. For patients and families, dying in hospital can be highly distressing. Persons with dementia are especially susceptible to negative hospital-related outcomes. This study aims to evaluate whether the Revised Medical Care Act is associated with a decrease in the proportion of hospital deaths for older adults and persons with dementia over a 20-year period covering the reform. Methods and findings This is a population-level, repeated cross-sectional study using mortality data from Vital Statistics Japan. Participants were Japanese older adults 65 years or older with and without dementia who died between 1996 and 2016. The policy intervention was the 2006 Revised Medical Care Act that increased community care infrastructure. The primary outcome was location of death in hospital, nursing home, home, or elsewhere. The trend in the proportion of location of death, before and after the reforms was estimated using an interrupted timeseries analysis. All analyses were adjusted for sex and seasonality. Of the 19,307,104 older adult decedents, 216,442 had dementia identified on their death certificate. Death in nursing home (1.10, 95% CI 1.10-1.10), home (1.08, 95% CI 1.08-1.08), and elsewhere (1.07, 95% CI 1.07-1.07) increased over time compared to hospital deaths for the total population after reform implementation. Nursing home (1.04, 95% CI 1.03-1.05) and home death (1.11, 95% CI 1.10-1.12) increased after reform implementation for persons with dementia.