Comprehensive Long-term Care Research Articles

Long-term care plan recommendation for older adults with disabilities: a bipartite graph transformer and self-supervised approach.

With the global population aging and advancements in the medical system, long-term care in healthcare institutions and home settings has become essential for older adults with disabilities. However, the diverse and scattered care requirements of these individuals make developing effective long-term care plans heavily reliant on professional nursing staff, and even experienced caregivers may make mistakes or face confusion during the care plan development process. Consequently, there is a rigid demand for intelligent systems that can recommend comprehensive long-term care plans for older adults with disabilities who have stable clinical conditions. This study aims to utilize deep learning methods to recommend comprehensive care plans for the older adults with disabilities. We model the care data of older adults with disabilities using a bipartite graph. Additionally, we employ a prediction-based graph self-supervised learning (SSL) method to mine deep representations of graph nodes. Furthermore, we propose a novel graph Transformer architecture that incorporates eigenvector centrality to augment node features and uses graph structural information as references for the self-attention mechanism. Ultimately, we present the Bipartite Graph Transformer (BiT) model to provide personalized long-term care plan recommendation. We constructed a bipartite graph comprising of 1917 nodes and 195240 edges derived from real-world care data. The proposed model demonstrates outstanding performance, achieving an overall F1 score of 0.905 for care plan recommendations. Each care service item reached an average F1 score of 0.897, indicating that the BiT model is capable of accurately selecting services and effectively balancing the trade-off between incorrect and missed selections. The BiT model proposed in this paper demonstrates strong potential for improving long-term care plan recommendations by leveraging bipartite graph modeling and graph SSL. This approach addresses the challenges of manual care planning, such as inefficiency, bias, and errors, by offering personalized and data-driven recommendations. While the model excels in common care items, its performance on rare or complex services could be enhanced with further refinement. These findings highlight the model's ability to provide scalable, AI-driven solutions to optimize care planning, though future research should explore its applicability across diverse healthcare settings and service types. Compared to previous research, the novel model proposed in this article effectively learns latent topology in bipartite graphs and achieves superior recommendation performance. Our study demonstrates the applicability of SSL and graph transformers in recommending long-term care plans for older adults with disabilities.

Medium term health and quality of life outcomes in a cohort of children with MIS-C in Cape Town, South Africa

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a disease that occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Its short-term effects have been documented but little data exist on the longer term effects of MIS-C on the health and quality of life (QOL) of patients. The objective of this study was to assess the long-term effects of MIS-C on the QOL of children.MethodsThis study was a descriptive prospective study. We included 24 participants with previous MIS-C and 20 children with juvenile idiopathic arthritis (JIA) as a positive comparator group. All children were examined and completed a paediatric quality of life (PedsQL) generic inventory score. This score was used to evaluate the School Functioning, Social, Emotional, and Physical QOL domains.ResultsAll participants with previous MIS-C made a full recovery, with no medical complaints, and normal physical examinations after a median of 705 days post acute diagnosis. The PedsQL inventory revealed that 16.7% of the children with previous MIS-C showed a deficit in the physical domain compared to 60% of the children with JIA (p < 0.001). 12.5% of the children with previous MIS-C had a deficit in their psychosocial domain which included emotional, social, and educational scores, compared to 40% of the children with JIA (p = 0.035).ConclusionsIn a cohort of 24 South African children with previous MIS-C, no medical complications were reported. A small proportion felt a prolonged effect on their QOL even after making a full recovery, although this was not as severe as children with JIA, a known chronic disease that affects QOL. This highlights the need to continue to follow up these patients and offer more comprehensive long-term care.

Трансформация систем здравоохранения и социального обеспечения в условиях старения населения: проект «Школа здоровья» в экосистеме «Московское долголетие»

All countries face the difficult task of preparing their health and social care systems to work as effectively as possible in the context of the demographic shift associated with population ageing. This paper presents a thematic review of scientific literature sources and an analysis of data provided by the State Budgetary Institution «Directorate for Coordination of Activities of Medical Organizations of the City of Moscow» of the Moscow Department of Health. Long-term comprehensive care for the ageing population of Moscow involves bringing the health care system in line with the needs of older people and creating a social environment and communities favorable for older people. The implementation of the initiative aimed at creating an environment favorable for older people within the framework of the «School of Health» project is a socially significant strategy in line with the state policy of promoting longer and healthier lives of people, maintaining a high quality of life and well-being in old age.

Factors associated with depressive and anxiety symptoms among anophthalmic patients wearing ocular prostheses

This study aimed to investigate the prevalence of anxiety and depression among individuals with ocular prostheses and to identify factors associated with these psychological symptoms. A sample of patients who underwent monocular enucleation and socket implantation participated in the study, responding to digital questionnaires covering demographics, psychosocial factors, and aspects related to their ocular prostheses. Depressive and anxiety symptoms were evaluated using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Optimal scale regression analysis was employed to explore factors linked to psychological symptoms in ocular prosthesis users. Results from 100 valid participants revealed a 51% prevalence of depressive symptoms and a 45% prevalence of anxiety symptoms. The mean PHQ-9 score was 4.91 ± 1.98, and the mean GAD-7 score was 4.99 ± 2.15. Factors such as undergoing right eye enucleation, longer duration of ocular prosthesis use, comfort with prosthesis wearing, and greater satisfaction correlated with milder depressive symptoms. In terms of anxiety, those who used ocular prostheses due to trauma or tumors were affected by more severe symptoms, while individuals who were comfortable with their prosthesis or using alumina-based prostheses reported fewer anxiety symptoms. In conclusion, ocular prosthesis users wrestle with significant challenges of depressive and anxiety symptoms. Factors including age, household registration, economic status, enucleation side, cause of anophthalmos, prosthetic material, and satisfaction and duration of prosthesis use were associated with depressive or anxiety symptoms. Long-term comprehensive care targeting these vulnerable individuals is imperative to alleviate depression and anxiety.

Development of a Patient-Centred Care Plan for Patients Requiring Maintenance Electroconvulsive Therapy Long-Term

IntroductionMaintenance electroconvulsive therapy (ECT) can be effective and necessary in the long-term for patients with severe and recurrent mood or psychotic disorders that are not amenable to any other forms of treatment. Patients with such treatment resistance affecting their ability to maintain minimal daily activities may eventually fall within the palliative psychiatric care domain in which advanced medical directives become an important beacon to direct care. There are Psychiatric Advance Directives which allow people with severe mental health conditions to consent to or refuse to consent to hospital admission and psychiatric treatment in the event they lose decision-making capacity and this can be especially important for a potentially controversial treatment such as ECT. However, the focus tends to be on enforcing involuntary treatment and less about a comprehensive long-term care plan. To our knowledge, there is no available framework to structure maintenance ECT as a patient-centred care plan.ObjectivesOur aim is to share the process of development of a patient-centred care plan for patients requiring maintenance ECT. Our objectives are: 1.Constant engagement with patients and family or caregivers2.Regular reviews of clinical and consent aspects of treatment3.Advocating for the welfare of patients and respect of values4.Focus on dignity especially for patients who require treatment well into old age5.Being prepared for termination of treatment if necessary MethodsWe reviewed our management of previous and existing patients on maintenance ECT and incorporated diligent consent-taking practices. Adopting good practices from known palliative approaches and involving the patient voice helped to form a framework for a patient-centred care plan.ResultsOur patient-centred care plan features half-yearly discussions about the risks and benefits of treatment, as well as an assessment of the patient’s cognition and ability to consent which may change over time. Opportunities for them to share their values and expectations of care and engagement with their caregivers about their quality of life guide the continued treatment. A framework for discussing the disruption or eventual termination of ECT prepares for scenarios where older-aged patients may develop frailty or present with acute, prolonged or devastating medical concerns. This end-of-life care approach manages anticipated psychiatric-specific behavioural concerns and prepares for the possibility of death following the planned termination of ECT for patients who required long-term treatment throughout their life. Lastly, issues of grief amongst caregivers and ethical concerns from medical staff are addressed.Conclusions We hope that our patient-centred care plan provides a well-considered conversation and structure for the initiation, continuation and termination of maintenance ECT in the long-term.Disclosure of InterestNone Declared

The Consequences of Unmet Needs for Assistance With Daily Life Activities Among Older Adults: A Systematic Review.

Many older adults are experiencing unmet needs for assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Such unmet needs might threaten their physical and psychosocial well-being. We conducted a systematic review to provide a comprehensive picture of the health consequences of unmet ADL/IADL needs among older adults. Twenty-eight published articles were included for qualitative synthesis. We found that unmet ADL/IADL needs were consistently associated with higher health care utilization (e.g., hospitalization, medical spending) and adverse psychosocial consequences (e.g., anxiety, depression), while the findings of falls and mortality remain inconsistent. More studies are needed to draw firm conclusions and to allow for quantitative synthesis. This review advocates for more coordinated and comprehensive long-term care services for older adults. Future studies should explore how the adverse health outcomes identified in this review can be prevented or improved by adequately meeting older adults' needs for assistance.

Factors influencing quality of life in early-stage upper gastrointestinal cancer patients in Nanchong city: a qualitative study.

To identify the determinants of quality of life (QoL) among early-stage upper gastrointestinal cancer (UGIC) patients in Nanchong City to inform the development of targeted treatment plans. In this retrospective study, 642 patients diagnosed with UGIC were included. A phenomenological approach was employed, involving in-depth face-to-face interviews to explore patients' real-life experiences with QoL, with an emphasis on spiritual and psychological aspects. Data analysis followed Colaizzi's seven-step method. Statistical analyses included one-way Analysis of Variance (ANOVA), t-tests, binary logistic regression, and Pearson correlation tests. QoL was significantly reduced in patients with early-stage GI cancer (P<0.001), with prevalent symptoms of anxiety and depression necessitating focused psychological interventions and enhanced medical care. Influential factors on QoL included income, health insurance coverage, illness duration, and levels of anxiety and depression (P<0.001). A strong negative correlation was observed between QoL scores and both the Hamilton Anxiety Scale (r=-0.7808, P<0.001) and the Hamilton Depression Rating Scale (r=-0.7493, P<0.001). This study underscores the substantial impact of anxiety and depression on the QoL of patients with early-stage UGIC. The findings provide a theoretical basis for implementing comprehensive long-term care strategies.

РАЗВИТИЕ СИСТЕМЫ ДОЛГОВРЕМЕННОГО УХОДА: ДЕМОГРАФИЧЕСКИЕ ФАКТОРЫ И СОЦИАЛЬНО-ЭКОНОМИЧЕСКИЕ ПРЕДПОСЫЛКИ

The subject of the study is the long-term care system in terms of providing healthcare and social security services for pensioners and disabled people. The purpose of the paper is to analyze and assess the demographic and socio-economic factors that influence the formation and development of the long-term care system in Russia. The relevance of the study stems from the rising proportion of the population above working age and specific aspects of their socio-economic status. The scientific novelty lies in the new approaches to building and advancing the long-term care system, emphasizing the need for it to be based on regional and territorial disparities in the provision of social and medical assistance to pensioners and disabled individuals, as well as the demographic characteristics of regional development. The study utilized factor analysis, generalization, grouping, comparison, and extrapolation, along with other methods, to identify the potential need for long-term care. This considered demographic factors and aimed to justify the introduction of long-term care systems with state support. The analysis also focused on socioeconomic factors and emphasized the aspects of formation and development of long-term care, while taking into account the territorial and regional specifics of Russia. The study aimed to provide scientific and practical results. The authors conclude that it is necessary to consider the existing features of territorial and regional development that do not provide equal access to health and social care services and the socio-economic situation of target categories of citizens when forming and developing a comprehensive long-term care system in Russia.

Perceptions of Stress and Engagement in High-Intensity Caregiving: A Cross-Sectional Study in Lithuania.

The aging population and overstretched healthcare systems are increasing demand for home nursing by informal caregivers, significantly affecting their mental health. This study aimed to examine the level of population's engagement in caregiving and the association between high-intensity caregiving and perceived caregiving stress in the general population of Lithuania. A nationally representative sample (N = 1000) of Lithuanian residents aged 18 years and older (mean age 53.1 ± 17.9 years) was interviewed in their households. The results showed that 17.4% (95% CI: 15.1, 19.8) of respondents were involved in home nursing activities to some extent, with 42% of these being high-intensity caregivers (providing 11 or more hours of home care per week). Caregivers were statistically significantly more likely to be female and have higher education levels. Perceived stress was significantly associated with higher education levels (OR = 2.66, 95% CI: 1.41, 5.02), high-intensity caregiving (OR = 2.14, 95% CI: 1.15, 3.97), regular involvement in home nursing (OR = 1.86, 95% CI: 1.01, 3.43), and caring for recipients with dementia or individuals entirely dependent on assistance (OR = 2.52, 95% CI: 1.22, 5.23). Caregivers perceived stress is associated with their level of education, the intensity and regularity of home nursing, as well as the level of dependency of the care recipient, especially in cases of dementia. Comprehensive long-term care policies should be developed to ensure the larger availability of formal care resources, increased societal participation in home nursing, and tailored interventions for high intensity caregivers.

Patterns of physical and mental co-occurring developmental health among Chinese elderly: A multidimensional growth mixture model analysis

BackgroundThis study focuses on the heterogeneity, interaction, and imbalance in the concurrent development of physical and mental health trajectories among Chinese elderly. MethodsThe data used in this study are from four waves of the China Health and Retirement Longitudinal Study (CHRLS) conducted between 2011 and 2018. A multidimensional growth mixture model (MGMM) was employed to analyze the patterns and characteristics of co-occurring physical and mental health development. Additionally, multinomial logistic regression analysis was conducted to systematically investigate the factors that predict the conjoint trajectories of physical and mental health. ResultsThe study findings reveal the presence of four distinct latent classes of conjoint trajectories for physical and mental health. These classes are categorized as follows: ‘physical and mental health deteriorating’, ‘physical disease increasing & low mental vulnerability maintaining’, ‘low physical & mental vulnerability maintaining’, and ‘high physical disease increased & mental health moderate-stable’. Furthermore, demographic characteristics, socioeconomic status, family-society relations, health behaviors, and institutional factors were found to significantly predict these latent classes. ConclusionThe study emphasizes the diversity and complexity of physical and mental co-occurring developmental health issues in the elderly population in China. These findings have significant implications for the development of targeted intervention strategies that take into account the unique health changes experienced by older adults. Additionally, they can serve as evidence for the establishment of a comprehensive long-term care system.

Bidirectional associations between hearing difficulty and cognitive function in Chinese adults: a longitudinal study.

Middle-aged and older adults frequently experience hearing loss and a decline in cognitive function. Although an association between hearing difficulty and cognitive function has been demonstrated, its temporal sequence remains unclear. Therefore, we investigated whether there are bidirectional relationships between hearing difficulty and cognitive function and explored the mediating role of depressive symptoms in this relationship. We used the cross-lagged panel model and the random-intercept cross-lagged panel model to look for any possible two-way link between self-reported hearing difficulty and cognitive function. To investigate depressive symptoms' role in this association, a mediation analysis was conducted. The sample was made up of 4,363 adults aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018; 44.83% were women; mean age was 56.16 years). One question was used to determine whether someone had a hearing impairment. The tests of cognitive function included episodic memory and intelligence. The Center for Epidemiologic Studies Depression Scale, which consists of 10 items, was used to measure depressive symptoms. A bidirectional association between hearing and cognition was observed, with cognition predominating (Wald χ2 (1) = 7.241, p < 0.01). At the between-person level, after controlling for potential confounders, worse hearing in 2011 predicted worse cognitive function in 2013 (β = -0.039, p < 0.01) and vice versa (β = -0.041, p < 0.01) at the between-person level. Additionally, there was no corresponding cross-lagged effect of cognitive function on hearing difficulty; rather, the more hearing difficulty, the greater the cognitive decline at the within-person level. According to the cross-lagged mediation model, depressive symptoms partially mediates the impact of cognitive function on subsequent hearing difficulty (indirect effect: -0.003, bootstrap 95% confidence interval: -0.005, -0.001, p < 0.05), but not the other way around. These results showed that within-person relationships between hearing impairment and cognitive function were unidirectional, while between-person relationships were reciprocal. Setting mental health first may be able to break the vicious cycle that relates hearing loss to cognitive decline. Comprehensive long-term care requires services that address depressive symptoms and cognitive decline to be integrated with the hearing management.

Integrating familial care and extra‐familial care into a new long‐term care policy for China: Examples from Germany's long‐term care insurance

AbstractRapid demographic ageing constitutes a significant challenge for the Chinese social system. As China has only recently begun developing a long‐term care (LTC) policy, care provision is currently based on family care. However, the prevalence of such care is declining due to low social recognition and conflicts between family members' care and work responsibilities. Thus, a comprehensive LTC policy should expand extra‐familial care services and make family care attractive. Germany's LTC insurance is an example of a policy that integrates extra‐familial and family care. This study analyses whether China's LTC policy can gain insights from Germany's LTC policy in view of the findings from Chinese LTC pilot projects. We argue that a policy that supports extra‐familial and family care would facilitate the LTC provision preferred by older people, while also supporting relatives who wish to provide care according to their values of intergenerational solidarity.

Long-term anatomical and functional outcomes of surgical treatment of retinal complications in children and adolescents with Stickler syndrome between 2004 and 2021.

Stickler syndrome (STL) is an inherited progressive connective tissue collagen disorder. STL is the most common hereditary cause of retinal complications, retinal tears, and the development of retinal detachment (RD) in childhood. The aim of the study was to evaluate the long-term anatomical and functional results of surgical treatment of retinal complications in children and adolescents affected by STL. A retrospective, single-center study was performed a cohort of children with STL who underwent retinal surgery between 2004 and 2021. The study group consisted of nine children; the mean age at the time of the retinal tear with/without retinal detachment was 7.2 (2-10) years, and the mean follow-up period was 9.6 (5-16) years. Pathogenic variants COL2A1 (5 children) and COL11A1 (3 children) were confirmed in our cohort. In total, we operated on 13 eyes, 11 eyes with complicated RD and two eyes with multiple retinal defects, but without RD. At the end of the follow-up period, an attached retina was achieved 77% (10 eyes) with or without silicone oil tamponade: cryopexy alone was successful in one eye (10%), scleral buckling (EB) in five eyes (50%), and vitrectomy with silicone oil tamponade combined with EB in four eyes (40%). The mean number of surgeries was 2.3 per eye. The resulting best corrected visual acuity ranged from 0.03 to 0.1 in one eye, from 0.16 to 0.4 in two eyes, and from 0.5 to 1.0 in 7 eyes. Repair of retinal tears with/without retinal detachment in patients with Stickler syndrome often requires multiple surgeries with combinations of cryopexy, scleral buckling, and/or vitrectomy with silicone oil tamponade. Treatment of the ocular complications arising from STL requires long-term comprehensive care.

Network Information Security Platform Based on Artificial Intelligence for the Elderly's Health "Integration of Physical, Medical, and Nursing Care".

With the development of my country's economy and society and the improvement of civilization, the silver wave has gradually come. The country has launched a multifaceted pension model, such as institutional pension, home-based pension, and pension real estate. With the increasing aging of the population, traditional elderly care services can no longer meet the growing needs of the elderly. This research mainly discusses the construction of a network information security platform based on artificial intelligence for the elderly's health “integration of physical, medical, and nursing care.” The platform consists of five modules: health records, follow-up plans, remote training, health education, and remote consultation. Each module is equipped with a corresponding main interface and/or subinterface. Some modules also have submodules as needed. The structure is reasonable, and the interface is displayed. The combined medical care service model is divided into medical care, care care, and medical care. Among them, the medical care model mainly provides long-term comprehensive care services for the disabled, demented, semidisabled, and other elderly groups. The support-oriented model is mainly for self-care or semi-self-care elderly groups, providing rehabilitation monitoring and life care services. In terms of the overall effect of the platform, 13 users (81.25%) gave a high evaluation of the overall effect of the platform. This research will promote the development of the smart elderly care industry.

Primary care-based follow-up for prostate and kidney cancer survivors: a retrospective monocentric study.

New follow-up models of care are needed to ensure long-term comprehensive care for cancer survivors. We investigated the impact of a general practitioner (GP)-led follow-up program for prostate cancer (PCa) and renal cell cancer (RCC) survivors. This retrospective monocentric study compared standard urologist-led follow-up to experimental GP-led follow-up within a nurse-led network for PCa and RCC survivors. To assess the safe continuity of follow-up, the number of patients lost to follow-up (LFU) was collected. A microcosting analysis from the French national health system perspective was conducted to describe incremental costs associated with experimental follow-up. A satisfaction survey was conducted to determine participating patient's and GP's satisfaction scores, ranging from 0 to 4 and 0 to 5, respectively. Among the 1274 patients included, 92/753 (12.2%) were LFU during standard follow-up vs 0/521 (0%) during experimental follow-up (p < 0.001). In the latter, the median management delay of suspected recurrence for PCa and RCC survivors was 20 [12-27] and 16 [10.5-31.25] days, and the mean incremental cost on a per-patient basis was 34.68 ± 105.87€ and 64.24 ± 93.55€, respectively. Patient and GP mean satisfaction scores were 3.6/4 and 3.9/5, respectively. The GP-led follow-up of PCa and RCC survivors within a nurse-led network seems to provide safe continuity of follow-up and seems not to be associated with major incremental costs. The surveys indicated high level of patient's satisfaction and encouraging results regarding GP's satisfaction. Randomized clinical trials are needed to confirm these findings and promote larger implementation of this type of follow-up care.

“Self-management has to be the way of the future”: Exploring the perspectives of speech-language pathologists who work with people with aphasia

Purpose: Healthcare models have incorporated self-management approaches to facilitate increased patient responsibility for chronic condition management. As aphasia is a chronic condition, self-management may be beneficial for people with aphasia; however, the possible impacts of the language disorder on self-management must be acknowledged and addressed. Speech-language pathologists would likely be principal providers of self-management support; therefore, their perspectives should be sought when considering development of aphasia self-management approaches. This study aims to explore speech-language pathologist perspectives of aphasia self-management. Method: In-depth, semi-structured interviews conducted with 15 speech-language pathologists in Australia. Interview data analysed using qualitative content analysis. Result: Aphasia self-management was viewed as a person- and family-centred approach enabling comprehensive long-term care for people with aphasia and promoting control, responsibility, and independence. Speech-language pathologists were seen to have a substantial role providing self-management support and consultation, and training was required to expand this role. Communication partners and peer support were highly valued. Personal and environmental factors may influence successful aphasia self-management. Differences between aphasia self-management and chronic condition self-management were considered. Conclusion: Self-management could facilitate long-term sustainable aphasia management. Aphasia self-management approaches should factor in how to maximise communication partner and peer support. Aphasia-friendly self-management resources are necessary.

Long-Term Follow-Up of Pediatric CNS Tumor Survivors-A Selection of Relevant Long-Term Issues.

Introduction: Survivors of pediatric central nervous system (CNS) tumors are at high risk for late effects and long-term morbidity. The quality of survival became increasingly important, as advances in diagnostics, multimodal treatment strategies, and supportive care have led to significant increases in long-term survival. Aim: This review aims to provide a global overview of the potential late effects and long-term follow-up care of CNS tumor survivors, directed to trainees and practitioners with less targeted training in pediatric oncology. Late effects in CNS tumor survivors: A specific focus on CNS tumor survivors relies on cognitive and psychosocial late effects, as they may have an impact on education, professional career, independent living, and quality of life. Further important late effects in CNS tumor survivors include endocrine, metabolic, cardiovascular, and cerebrovascular diseases. Conclusions: Comprehensive long-term follow-up care is essential for pediatric CNS tumor survivors to improve their quality of survival and quality of life. An individualized approach, taking all potential late effects into account, and carried out by an interdisciplinary team, is recommended, and should continue into adulthood. Existing recommendations and guidelines on long-term follow-up care guide the multidisciplinary teams.

Direct Medical Costs of Parkinson's Disease in Southern China: A Cross-Sectional Study Based on Health Insurance Claims Data in Guangzhou City.

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. This study aims to evaluate the direct medical costs of patients with PD using a large sample from an entire city and to identity the potential factors correlating with their inpatient costs in Guangzhou City, Southern China. Methods: This retrospective cross-sectional study uses data obtained from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. The total sample was comprised of 2660 patients with PD. Costs were evaluated for the total sample and by types of insurance. The composition of costs was compared between the UEBMI and URBMI subgroups. The extended estimating-equations model was applied to identify the potential impact factors influencing the inpatient costs. Results: The direct medical costs per patient with PD were CNY 14,514.9 (USD 2299.4) in 2012, consisting of inpatient costs of CNY 13,551.4 and outpatient costs of CNY 963.5. The medication costs accounted for the largest part (50.3%). The inpatient costs of PD patients under the UEBMI scheme (CNY 13,651.0) were significantly higher than those of patients in the URBMI subgroup (CNY 12,402.2) (p < 0.05). The proportion of out-of-pocket spending out of inpatient and outpatient costs for UEBMI beneficiaries (24.3% and 56.1%) was much lower than that for patients under the URBMI scheme (47.9% and 76.2%). The regression analysis suggested that types of insurance, age, hospital levels, length of stay (LOS) and comorbidities were significantly correlated with the inpatient costs of patients with PD. Conclusions: The direct medical costs of patients with PD in China were high compared to the GDP per capita in Guangzhou City and different between the two evaluated types of insurance. Patients with the UEBMI scheme, of older age, with comorbidities, staying in tertiary hospitals and with longer LOS had significantly higher inpatient costs. Thus, policymakers need to reduce the gaps between the two urban insurance schemes in benefit levels, provide support for the development of a comprehensive long-term care insurance system and promote the use of telemedicine in China.

Geriatrics Perspectives From Japan

In 2025, Japan’s baby boomers will cross the threshold of 75 years of age; a phenomenon that has been referred to as “the 2025 crisis”, resulting in a significant burden on the healthcare system. To address this issue, the Japanese government is establishing the Integrated Community Care System, to provide comprehensive medical and long-term care services in each community. In cooperation with government and affiliated organizations, the Japan Geriatrics Society (JGS) has been working to develop the Integrated Community Care System. As a result of this effort, geriatric medicine is being integrated into the health care system through incentives for practitioners. For instance, medical facilities can be reimbursed if they perform comprehensive geriatric assessments (CGA) and CGA-based management/care. Additionally, home care medicine and polypharmacy are emerging issues of interest to the government. In this symposium, I will discuss how JGS has been trying to achieve “Aging in Place” in Japan.

Care Policy in Slovenia: Divergent Trends and Convergent Attitudes

Slovenia makes a compelling case for care policy analysis since it is marked by extreme dichotomy in care. Therefore, placing Slovenia on a continuum of care regimes ranging from defamilialised to familialised with respect to care is difficult, with care for children being highly defamilialised, and care for older people highly familialised. The country’s childcare policies build on a historically well-developed system of public childcare provision and generous leave policies, together with a well-developed social protection system targeting families. These have been retained and, in some cases, were expanded, still following the 2009 economic crisis, certain austerity measures were introduced. On the other hand, care policies for older people started to develop later and after the initial growth they relatively stagnated (especially the social homecare system). A comprehensive long-term care system has yet to be developed and become a subject of ongoing political debates. Further, unlike in childcare, the increasing role of private actors can be observed in this sector. In the article, we discuss these care policy developments in Slovenia in terms of the role of relevant actors (state, family, private actors) with an emphasis on the views of people regarding care, based on data gathered within an innovative method of democratic forums. The article reveals that the dichotomy of care policies, as well as the differing recent trends in family policies for children and care for older people, is not present in people’s attitudes and their preferences for the arrangement of such policies. Key words: care, social policy, Slovenia, older people, childcare, democratic forum, attitudes.