Abstract
Outpatient rehabilitation (OR) and outpatient day long-term care (ODLC) services are frequently used by older adult patients in Japan. However, there is a need to clarify that OR service, which has more rehabilitation professionals than ODLC, has the role of providing rehabilitation. This retrospective study examined the impact of OR services by comparing the two services based on City A data from the care-needs certification survey conducted between 2015 to 2017. We performed a propensity score matched analysis to compare the changes in the care level and function of OR and ODLC users after two years. The results showed that OR users showed a lower deterioration in care levels and less decline in the activities of daily living (ADL) in dementia and adaptation to social life. In the analysis of older adults requiring support, OR users had a lower deterioration in care levels and less decline in the ADL in dementia and behavioral and psychological symptoms than ODLC users did. There was no difference between the two services with respect to older adults requiring long-term care. The OR service has had an increasingly preventive effect on the deterioration of care levels compared to the ODLC service, which was particularly evident in older adults requiring support.
Highlights
Many developed countries face the problem of population aging, as the proportion of older adults requiring care has increased globally [1]
We used a logistic regression of the following factors for the propensity score calculation: age, sex, level of care needed, the degree of independent daily living for disabled older adults, the degree of independent daily living for older adults with dementia, body function/bed mobility, daily life function, cognitive function, behavioral and psychological symptoms, and adaptation to social life
Significant differences were observed between the sex (p < 0.001), body function/bed mobility (p = 0.007), cognitive function (p = 0.010), behavioral and psychological symptoms (p < 0.001), level of care needed (p < 0.001), and the degree of independent daily living for older adults with dementia (p < 0.001) before the propensity score matching
Summary
Many developed countries face the problem of population aging, as the proportion of older adults requiring care has increased globally [1]. Japan has become a super-aging society due to its high life expectancy and low birth rate [2,3]. The proportion of older adults (aged ≥ 65 years) in Japan was the highest worldwide in 2017 at 27.7%, which is predicted to increase to about 40%. Geriatric syndromes refer to multi-etiological disorders associated with physiological aging, representing a major problem in aging populations. Falls, cognitive impairment, and urinary incontinence are the most common geriatric syndromes [5]. Under the Japanese long-term care insurance (LTCI), many issues requiring nursing care are associated with geriatric syndromes, including dementia (18.7%), fall/fractures (12.5%), and frailty (13.8%) [4]
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