Long-term Care Insurance Certification Research Articles

Combined Effect of Slow Gait Speed and Depressive Symptoms on Incident Disability in Older Adults

ObjectivesTo elucidate whether a combination of slow gait speed and depressive symptoms result in higher risk of incident disability in older adults than either symptom individually. DesignProspective cohort study. SettingObu City, Aichi Prefecture, Japan. ParticipantsParticipants were 4038 older adults (48.7% male, mean age = 71 years) who met the study inclusion criteria. MeasurementsLongitudinal data on incident disability were collected up to 33 months [median 31 months (interquartile range 29–32 months)] after baseline. We monitored monthly incident disability, defined as Japanese long-term care insurance certification for personal support or care. Baseline measurements included covariates for incident disability, gait speed, and the Geriatric Depression Scale for assessing depressive symptoms. The associations between slow gait, depressive symptoms, or their co-occurrence, and incident disability were examined. ResultsControl participants were the reference in an adjusted Cox proportional hazard regression model. Participants with co-occurring slow gait and depressive symptoms showed a greater risk of incident disability [hazard ratio (HR) 3.08, confidence interval (CI) 95% 2.00–4.75]. Greater risk was also found for participants with slow gait speed alone (HR 2.44, CI 95% 1.71–3.47) and depressive symptoms alone (HR 1.60, CI 95% 1.01–2.53). ConclusionsOlder adults with both risk factors may require early detection and physical and psychological intervention.

The prevalence of homebound individuals in the elderly population: a survey in a city area in Japan.

Being homebound has been reported to be associated with a number of conditions. In the current study, the incidence of homebound individuals was surveyed in an urban city area in Japan. The city office randomly enrolled 5,000 residents of Nagoya City aged 65 and over. A questionnaire was sent to their principal caregivers by mail, and 3,444 (68.9 %) subjects returned the survey. The investigators obtained the totally anonymous data from the city office. This study was approved by the Ethics Committee of Nagoya University Graduate School of Medicine. In the present study, the data of 3,053 (61.1 %) subjects for whom complete sets of data were available were employed for statistical analysis. The questionnaire included the following items: age, sex, the status of public long-term care insurance certification (none, support-level, care-level), self-rated health (good, fair, poor, very poor), states of living (single living, with only spouse, with other family members), and the frequency of outside excursions per a week (every day, once in a few day, one a week, rarely). An individual was defined as being homebound if his or her frequency of outside excursions was less than once per week. he incidence of the homebound elderly in the elderly population over 65 years old was 14.4 % in the current study. The status of certification in public long-term care insurance was associated with being homebound. Self-rated health was significantly worse in homebound individuals than in those non-homebound. The current survey found 14.4 % of the elderly was home-bound in a large city in Japan.

「低栄養と介護保険認定・死亡リスクに関するコホート研究」を拝見して

「低栄養と介護保険認定・死亡リスクに関するコホート研究」を拝見して

低栄養と介護保険認定・死亡リスクに関するコホート研究 鶴ヶ谷プロジェクト

低栄養と介護保険認定・死亡リスクに関するコホート研究 鶴ヶ谷プロジェクト

地域在住高齢者の要介護認定のリスク要因の検討 AGES プロジェクト 3 年間の追跡研究

地域在住高齢者の要介護認定のリスク要因の検討 AGES プロジェクト 3 年間の追跡研究

うつ状態と介護保険要支援・要介護認定リスクとの関連 鶴ヶ谷プロジェクト

うつ状態と介護保険要支援・要介護認定リスクとの関連 鶴ヶ谷プロジェクト

The Decision-Making and Communication Capacities of Older Adults with Dementia: A Population-Based Study

The present study assessed the decision-making and communication capacities of older adults with dementia who required assistance and care and measured the subsequent changes in these capacities. Of 845 older adults who received long-term care between April 2003 and December 2004, about half of them without dementia were excluded and the remaining 448 were finally included in the analyses. These individuals were completed follow-up for assessment for two years. The data were obtained from the Long-Term Care Insurance Certification Committee for Eligibility in Gujo City. A total of 73.7% of people with dementia were somewhat capable of making decisions (32.4% were reported as being “always capable”; 41.3% were reported as being “sometimes capable”). A total of 93.7% were somewhat capable of communicating with others (78.3% were reported as being “always capable”; 15.4% were reported as being “sometimes capable”). The results indicate that older adults with dementia can participate in their own care decisions, even if they require assistance and support in their daily lives. The present study shows, however, that baseline decision-making capacity declined to about half what they were after one year and to about one-third of what they were after two years, suggesting that earlier efforts are needed to ensure that the preferences of individuals with dementia are reflected in their care.

地域高齢者におけるかかりつけ歯科医の有無と要介護認定に関する コホート研究：鶴ケ谷プロジェクト

地域高齢者におけるかかりつけ歯科医の有無と要介護認定に関する コホート研究：鶴ケ谷プロジェクト

Evaluation of multimodal factors for the certification of long-term care insurance among community-dwelling elderly: a four-year follow-up study.

The aim of this study was to examine risk factors for the certification of long-term care insurance (hereafter reffered to as "certification") in the community-dwelling elderly individuals. At baseline, 4,503 community-dwelling elderly responded to a self-completed questionnaires including items for "certification". Among the respondents, we analyzed 4,213 individuals with a non-support status who provided data regarding sex. The endpoint was the onset of "certification". At the end of the four-year follow-up period, 313 subjects had received "certification" (support-transition group), while the remaining 3,639 subjects continued to exhibit a non-support status (non-support group). The support-transition group contained a higher proposion of subjects with chronic disease than the non-support group. The presence of chronic disease, a poor condition of the eyes or teeth, infrequent medical checkups, a high BMI, changes in body weight within one year, sleep disturbances, poor appetite, impaired ambulation, a slow speed while walking and a history of fall(s) within the previous one year were found to be significantly related to an increased risk of "certification". These items differed between men and women. This longitudinal study demonstrated that risk factors related to "certification" among community-dwelling elderly are multimodal and differ between men and women. The presence of chronic disease, the level of health management and the ability to engage in physical activity at baseline exhibited significant correlations with the need for "certification" over the four-year study period.

The Determinants and Mechanisms of Agent Responsiveness for the Implementation Process of Care-Needs Certification for Long-Term Care Insurance: Evidence from Surveys Conducted in the Fukui Prefecture, Japan

The Determinants and Mechanisms of Agent Responsiveness for the Implementation Process of Care-Needs Certification for Long-Term Care Insurance: Evidence from Surveys Conducted in the Fukui Prefecture, Japan

The Yabu cohort study: design and profile of participants at baseline.

BackgroundFurther evidence into the effects of social relationships on health (including those at both the individual and community levels) is needed in Japan. The Yabu Cohort Study was launched in 2012 to identify the associations between social relationships and health among community-dwelling older Japanese people and to evaluate population approaches for preventive long-term care in the community. This report describes the study design and the profile of the participants at baseline.MethodsThe Yabu Cohort Study is a prospective study of community-dwelling individuals aged 65 years and older in Yabu, Hyogo Prefecture, Japan. The baseline survey, using a mailed self-administered questionnaire, was conducted from July through August 2012. It included information on socioeconomic status, general and psychological health, and social relationships (social network, social support, and social capital). Survival time, long-term care insurance certification, and medical and long-term care costs after the baseline survey will be followed.ResultsOf 7271 questionnaires distributed, a total of 6652 were returned (91.5% response rate), and 6241 were included in the analysis. Mean age was 71.9 ± 5.2 years, 43.2% were men, and 83.8% had lived in their neighborhood for more than 40 years. Approximately 45.2% expressed general trust. About 82.4%, 49.9%, and 55.5% have participated in neighborhood association activities, municipal seminars for preventive long-term care, and salon activities in the community, respectively.ConclusionsThe study is expected to provide valuable evidence on the effects of social relationships on health and to suggest the usefulness of population approaches for preventive long-term care in Japanese communities.

Cognitive Decline Predicts Long-Term Care Insurance Requirement Certification in Community-Dwelling Older Japanese Adults: A Prospective Cohort Study

Aim: The purpose of this prospective cohort study is to examine whether cognitive decline is an independent predictor of new long-term care insurance (LTCI) requirement certifications in Japan. Methods: A total of 5,765 community-dwelling older Japanese adults who, at baseline, were independent in terms of their activities of daily living participated in this study and were followed up for 18 months. The outcome measure was the number of new LTCI requirement certifications during the 18-month period of the study. We collected demographic information through questionnaires and assessed cognitive skills with the Cognitive Performance Scale (CPS). The participants were divided into 3 groups according to CPS scores (0, 1, and 2 or greater). Results: During the 18-month period, 399 subjects (6.9%) became newly certified for LTCI services. In a multivariate Cox proportional hazards model, older participants with a CPS score of 1 (adjusted HR: 1.39, 95% CI: 1.08-1.77) and 2 or greater (adjusted HR: 2.27, 95% CI: 1.74-2.96) were significantly more likely to receive an LTCI certification compared to those with a CPS score of 0. Conclusions: Cognitive decline is an independent predictor of new LTCI requirement certifications and the severity of cognitive decline in elderly adults is positively associated with receiving an LTCI requirement certification in Japan.

The predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability.

To compare the predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability in community-dwelling elderly persons. Prospective cohort study. Participants were 813 aged 70 years and older, elderly Japanese residing in the community, included in the Tsurugaya Project, who were not disabled at the baseline in 2003. Physical function was assessed by the questionnaire of "Motor Fitness Scale". Physical performance measures consisted of maximum walking velocity, timed up and go test (TUG), leg extension power, and functional reach test. The area under the curve (AUC) of the receiver operating characteristic curve for disability was used to compare screening accuracy between Motor Fitness Scale and physical performance measures. Incident disability, defined as certification for long-term care insurance, was used as the endpoint. We observed 135 cases of incident disability during follow-up. The third or fourth quartile for each measure was associated with a significantly increased risk of disability in comparison with the highest quartile. The AUC was 0.70, 0.72, 0.70, 0.68, 0.69 and 0.74, for Motor Fitness Scale, maxi- mum walking velocity, TUG, leg extension power, functional reach test, and total performance score, respectively. The predictive power of physical function assessed by the Motor Fitness Scale was equivalent to that assessed by physical performance measures. Since Motor Fitness Scale can evaluate physical function safely and simply in comparison with physical performance tests, it would be a practical tool for screening persons at high risk of disability.

Relationship Between Serum Isoflavone Levels and Disability-Free Survival Among Community-Dwelling Elderly Individuals: Nested Case-Control Study of the Tsurugaya Project

The longer healthy life expectancy observed in Japan may be partly attributed to the Japanese diet. The researchers sought to examine whether serum isoflavone levels are associated with disability and death. The researchers used a nested case-control study to compare serum isoflavones (daidzein, genistein, glycitein, and equol) levels between 165 participants that died or were certificated as disabled (cases) and 177 controls. Disability was defined by certification of long-term care insurance. Conditional logistic regression models were used to calculate the risk of isoflavones for the composite outcome. The proportion of cases was lower in the group with the highest levels of equol (34/91, 37%) compared with equol nonproducers (84/161, 52%). The risk of disability or death among equol producers remained reduced after adjusting for age and sex (odds ratio: 0.55, 95% confidence interval: 0.33-0.93). In a multivariate model, this risk was also unchanged (odds ratio: 0.51, 95% confidence interval: 0.27-0.96). There were no significant associations between daidzein, genistein, and glycitein with the composite endpoint. Higher serum equol levels, but not any other isoflavones, were inversely associated with the composite endpoint of disability and death. Although it cannot be concluded that equol per se has preventive effects on disability or death, higher equol levels appear associated with better health.

The Hatoyama Cohort Study: Design and Profile of Participants at Baseline

BackgroundInvestigation of frailty among elderly adults and development of prevention strategies to address this are critical in delaying progression of functional decline and thus extending healthy life expectancy. However, there has been no Japanese epidemiologic cohort study of frailty. The Hatoyama Cohort Study was launched in 2010 to identify factors that predict functional decline and to establish strategies to prevent frailty among community-dwelling elderly Japanese. This report describes the study design and the profile of the participants at baseline.MethodsThe Hatoyama Cohort Study is a prospective study of community-dwelling individuals aged 65 years or older living in the town of Hatoyama in Saitama Prefecture, Japan. Comprehensive information, including socioeconomic status, physiological indicators, physical, psychological, and cognitive function, social capital, neighborhood environment, and frailty, was collected in a baseline survey using face-to-face interviews in September 2010. Survival time, long-term care insurance certification, and medical and long-term care costs after the baseline survey will be followed. In addition, a follow-up survey will be conducted in the same manner as the baseline survey every 2 years.ResultsA total of 742 people participated in the baseline survey (mean age: 71.9 ± 5.2 years, men: 57.7%, living alone: 7.7%). Almost all participants were independent in their daily lives, and approximately 10% were categorized as frail on the kaigo-yobo (care prevention) checklist.ConclusionsThe Hatoyama Cohort Study is expected to contribute to the development of strategies that prevent frailty in later life and extend healthy life expectancy in Japan’s rapidly aging society.

大都市在住高齢者の精神的健康度の分布と関連要因の検討．要介護要支援認定群と非認定群との比較

The present study aimed to (1) examine the mental health well-being of urban community-dwelling elderly individuals; and (2) examine factors related to mental health well-being of those with long-term care insurance certification (LTCI+) and those without LTCI certification (LTCI-). We conducted a community-based, cross-sectional study that included 3,905 subjects aged 65 years or older living in Tokyo, Japan. A self-administered questionnaire was mailed to each participant. Mental health well-being was assessed using the Japanese version of the World Health Organization Mental Health Wellbeing Index--five items (WHO-5). Of the 2,431 respondents (response rate, 63.5%), 1,954 who completed WHO-5 were analyzed (241 LTCI+; 1,713 LTCI-). The total score of WHO-5 was 15.61±6.08 among all subjects; when a cut-off criterion of 12/13 was used, the frequency of low mental health well-being was 29.5% among all subjects. In a stratified analysis according to LTCI certification using multivariate logistic regression analysis, small social support network, heart disease, and daytime sleepiness were independently associated with low mental health well-being for the LTCI+ group; low education level, small social support network, low subjective health, daytime sleepiness, and worries about forgetfulness were independently associated with low mental health well-being for the LTCI- group. To improve mental health well-being of community-dwelling elderly individuals with LTCI certification, attention should be focused on those with small social network or daytime sleepiness. To improve mental health well-being of community-dwelling elderly individuals without LTCI certification, attention should be focused on those with small social network, low subjective health, or worries about forgetfulness.

Application for Certification of Long-term Care Insurance and Intention of Using Its Services among Elderly People Not Presently Utilizing These Services But Requiring Them to a Slight Extent(Community Health Nursing Reports)

Application for Certification of Long-term Care Insurance and Intention of Using Its Services among Elderly People Not Presently Utilizing These Services But Requiring Them to a Slight Extent(Community Health Nursing Reports)

Cohort Profile: The AGES 2003 Cohort Study in Aichi, Japan

BackgroundThe longevity of Japanese is thought to be associated with psychosocial factors such as sense of coherence, social support, and social capital. However, the actual factors responsible and the extent of their contribution to individual health status are not known.MethodsThe Aichi Gerontological Evaluation Study (AGES) 2003 Cohort Study is a prospective cohort study of community-dwelling, activities of daily living-independent people aged 65 or older living in 6 municipalities in Chita peninsula, Aichi Prefecture, Japan. Information on psychosocial factors and other individual- and community-level factors was collected in the second half of 2003 using a baseline questionnaire. Vital status and physical and cognitive decline have been followed using data derived from long-term care insurance certification. Geographical information on the study participants was also obtained.ResultsA total of 13 310 (6508 men; 6802 women) study participants were registered in the study. For an interim report, we followed the cohort for 48 months, yielding 24 753 person-years of observation among men and 26 456 person-years among women.ConclusionsThe AGES 2003 Cohort Study provides useful evidence for research in social epidemiology, gerontology, and health services.

Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: The Ohsaki Cohort 2006 Study

Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: The Ohsaki Cohort 2006 Study

The Ohsaki Cohort 2006 Study: Design of Study and Profile of Participants at Baseline

BackgroundLarge-scale cohort studies conducted in Japan do not always include psychosocial factors as exposures. In addition, such studies sometimes fail to satisfactorily evaluate disability status as an outcome.MethodsThis prospective cohort study comprised 49 603 (22 438 men and 27 165 women) community-dwelling adults aged 40 years or older who were included in the Residential Registry for Ohsaki City, Miyagi Prefecture, in northeastern Japan. The baseline survey, which included psychosocial factors, was conducted in December 2006. Follow-up of death, immigration, cause of death, cancer incidence, and long-term care insurance certification was started on 1 January 2007.ResultsThe response rate was 64.2%. In general, lifestyle-related conditions in the study population were similar to those of the general Japanese population; however, the proportion of male current smokers was higher in the cohort. The association between age and the proportion of those reporting psychological distress showed a clear U-shaped curve, with a nadir at age 60 to 69 years in both men and women, although more women were affected by such distress than men. The proportion of those who reported a lack of social support was highest among those aged 40 to 49 years. Most men and women surveyed did not participate in community activities. Among participants aged 65 years or older, 10.9% of participants were certified beneficiaries of the long-term care insurance system at baseline.ConclusionsThe Ohsaki Cohort 2006 Study is a novel population-based prospective cohort study that focuses on psychosocial factors and long-term care insurance certification.