Long-term Care Insurance System Research Articles

Comparison survey on family caregivers of older persons in Japan and Thailand.

While rapid population ageing is occurring worldwide, its speed is especially prominent in Asian countries. In Asia, cultural diversity might significantly affect care burden; however, few studies have investigated the differences in care burden, and mental, physical and social conditions among Asian countries. This study aimed to clarify the situations of and differences in family caregivers (FCs) of older persons in Japan and Thailand, and evaluate the factors associated with care burden in both countries. A cross-national survey of 217 in-home FCs was conducted in Japan and Thailand and mainly included items regarding care burden and psychosocial conditions. Differences between the two countries were obtained, and the factors associated with care burden were analysed by multiple regression analyses. The FCs' and care receivers' mean ages (64.8 ± 11.1 and 84.8 ± 8.6 years, respectively) in Japan were significantly higher than the mean ages (49.1 ± 13.3 and 77.1 ± 9.5 years) in Thailand. In Japan, FCs had more severe care burden, loneliness, and stress compared to those in Thailand. In Thailand, FCs had more social connections and informal support than those in Japan. The factors associated with care burden were different in each country; thus, severe stress, low emotional care preparation, and low willingness to continue care at home were significantly associated with severe care burden in Japan, whereas poor relationships with care receivers, few social connections, low confidence in providing care, low emotional care preparation, and lack of informal support were significantly associated with severe care burden in Thailand. Despite there being a long-term care insurance system in Japan, which is absent in Thailand, care burden and psychosocial conditions of FCs might be worse in Japan. There was a clear difference in the factors associated with care burden between Japan and Thailand.

The impact of long-term care insurance pilot on the mental health of older adults: Quasi-experimental evidence from China

The Chinese government launched pilot programs for a long-term care insurance system in response to the ongoing increase in the aging population. This study uses the difference-in-differences (DID) model to analyze the impact of long-term care insurance on older adults' mental health based on China Health and Retirement Longitudinal Study (CHARLS) four-period panel data from 2011 to 2018. This study found that long-term care insurance reduced Center for Epidemiological Studies Depression Scale (CES-D) scores among older adults by 1.059 points. Moreover, there was an improvement of 0.181 and 0.870 points in mental status and scenario memory scores, respectively. The impact of the long-term care insurance pilot program on improving the mental health of older adults was more pronounced, especially for those with chronic diseases or disabilities as well as those living in rural and western regions. This study also revealed that long-term care insurance enhances mental health by reducing medical expenses and increasing daily companionship and social interaction. Therefore, a pilot study of long-term care insurance showed a significant improvement in the mental health of older adults. To provide a comprehensive care service system for older adults, the government should expand the scope of the pilot program and increase the accessibility of mental health services for older adults.

Sleep duration, its change, and risk of dementia among Japanese: The Japan Public Health Center-based Prospective Study

ObjectivePrevious findings on the association between sleep duration, changes in sleep duration, and long-term dementia risk were mixed. Thus, we aimed to investigate the association between midlife sleep duration, its change, and dementia. MethodsWe recruited 41,731 Japanese (40–71 years) and documented their habitual sleep duration at baseline (1990–1994) and a 5-year follow-up survey. Changes in sleep duration were calculated as differences between baseline and 5-year measurements. We identified dementia using the Long-Term Care Insurance system (2007–2016). Hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia were calculated using the area-stratified Cox model. ResultsDuring 360,389 person-years, 4621 participants exhibited dementia. The multivariable HRs of dementia compared with 7 h of sleep were 1.13 (95% CI: 0.98–1.30) for 3–5 h, 0.93 (0.85–1.02) for 6 h, 1.06 (0.99–1.14) for 8 h, 1.13 (1.01–1.27) for 9 h, and 1.40 (1.21–1.63) for 10–12 h with a J-shaped fashion (p for linear < 0.001 and quadratic < 0.001). For its change, the HRs compared with no change were 1.02 (0.90–1.16) for decreased ≥2 h, 0.95 (0.88–1.03) for decreased 1 h, 1.00 (0.91–1.09) for increased 1 h, and 1.37 (1.20–1.58) for increased ≥2 h. The positive association for decreased sleep duration was observed in individuals with an initial sleep duration of ≤7 h, but not in those with ≥8 h (p for interaction = 0.007). ConclusionsLong and increased sleep duration was associated with a higher risk of dementia.

Impact of Japan’s Aging Population on Healthcare Costs and the Long-Term Care Insurance System

Japan’s demographic landscape is rapidly changing, leading to an unprecedented increase in the aging population. This demographic shift presents significant challenges for the healthcare system, particularly in escalating healthcare costs and the sustainability of the Long-term Care Insurance (LTCI) system. This paper examines the impact of these demographic changes on healthcare costs and evaluates the current LTCI system’s ability to meet the increasing demand for elderly care services. Through a thorough review of existing literature, demographic data analysis, and policy evaluation, this study proposes strategic recommendations to ensure the sustainability and effectiveness of Japan’s healthcare system in the face of an aging society.

Impact of LTCI on Degree of Life Satisfaction and Psychological Blessedness of the Elderly Population: An Empirical Analysis of Psychological Mechanisms and Moderating Effects

Objectives: In order to keep a proactive watch on the economic aspect of old age care, the Chinese government strives not only to build the sense of life satisfaction and blessedness in families, but also ensure social development through social support mechanisms, including the Long-Term Care Insurance (LTCI) plan. This study examines the impact of LTCI on the degree of life satisfaction and psychological blessedness of the old and further investigates the psychological mechanisms and moderating factors involved. Methods: In order to use authentic data related to coping measures for population aging, the CHARLS (China Health and Retirement Longitudinal Study) database was chosen to examine the impact of the LTCI system. Results: The study results found that LTCI significantly improved the degree of life satisfaction of middle-aged and older people. The effect was found to be heterogeneous at the level of gender, marital status, and the number of children through heterogeneity analysis. The results revealed that LTCI had a significant improvement effect on the degree of life satisfaction of middle-aged and older adults, particularly of the male population, in variables such as marital status, having fewer children, increased intergenerational financial support, all of which wove a mechanism showing how LTCI made an improvement effect on the degree of life satisfaction of middle-aged and older people. Conclusion: These results are of great significance in promoting the formulation and implementation of LTCI policies. It provides useful insights to the government, social organizations, and individuals with a scientific basis for the impact of LTCI on the mental health of the old. It also provides a valuable reference for improving the quality of life and blessedness of the elderly population.

Patterns of long-term care service use and multimorbidity in older Japanese adults: A cross-sectional study of claim data.

The long-term care (LTC) insurance system provides a combination of several services in Japan; therefore, it is important to clarify service utilization. Furthermore, it is important to consider multimorbidity among older adults, who frequently present several diseases. This study aimed to clarify LTC service utilization patterns, including those for newly added multifunctional services, and to describe the basic characteristics, including multimorbidity, of these patterns. We included 37 419 older adults in care need levels 1-5, living at home, who used LTC services in October 2017. We used LTC and medical claims data that were linked using unique identifiers from the National Health Insurance, Advanced Elderly Medical Insurance, and LTC Insurance of Shizuoka Prefecture in Japan. LTC service utilization patterns were identified using cluster analysis based on service fees. Multimorbidity was analyzed using the Charlson Comorbidity Index (CCI) and compared characteristics in these patterns. Six LTC service utilization patterns were identified: light use (51.0%), intensive use of day care (33.7%), intensive use of short stay (6.3%), intensive use of home help (5.1%), multifunctional LTC in small-group homes (MLS) use (3.7%), and MLS and home-visiting nurses (MLSH) use (0.2%). MLSH use had the highest CCI (3.6 ± 2.3). Intensive use of day care and short stay had the lowest CCI (2.6 ± 1.9). The characteristics of multimorbidity differed by LTC service utilization patterns. Our findings are useful for considering service utilization that takes into account the characteristics of older adults. Geriatr Gerontol Int 2024; 24: 283-289.

Do older adults with disability face home care poverty? Evidence from China

ABSTRACT Home care poverty is the inability of older people to access adequate home care services and their unmet needs for home care. With the increasing number of older adults (60 years old and above) with disability in China, the Chinese government pays more and more attention to home care. In this case, it is of great significance to explore whether older adults with the disability face home care poverty and its influencing factors. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 were utilized. SPSS 22.0 was used as a data analysis tool to conduct descriptive statistics and multiple logistic regression analysis on the sample (n = 1932). The study found that in 2018, 48.0% of older adults with disability faced home care poverty. Multiple logistic regression results showed that degree of disability, age, rural and non-eastern regions, income poverty, family caregiver, and reluctant caregivers were positive factors that increased the risk of home care poverty in disabled older adults (p < .05). But care duration, care expenditure, social pensions insurance, community daily life care and community medical services are the positive factors to eliminate the home care poverty for older adults with disability (p < .05). In order to solve the problem of home care poverty of older adults with disability, based on the research conclusions, the study proposed to establish a long-term care insurance system, formulate supportive policies for family caregivers or their families, and establish a wide variety of community care services.

Changes in dementia treatment patterns associated with changes in the National Policy in South Korea among patients with newly diagnosed Alzheimer’s disease between 2011 and 2017: results from the multicenter, retrospective CAPTAIN study

BackgroundThe South Korean government has been actively involved in plans to combat dementia, implementing a series of national strategies and plans since 2008. In July 2014, eligibility for mandatory long-term care insurance (LTCI) was extended to people with dementia enabling access to appropriate long-term care including the cognitive function training program and home nursing service. This study aimed to investigate changes in treatment patterns for Alzheimer’s disease (AD) between July 2011 and June 2017 which spanned the 2014 revision.MethodsThis multicenter, retrospective, observational study of patients with newly diagnosed AD analyzed electronic medical records from 17 general hospitals across South Korea. Based on their time of AD diagnosis, subjects were categorized into Cohort 1 (1 July 2011 to 30 June 2014) and Cohort 2 (1 July 2014 to 30 June 2017).ResultsSubjects (N=3,997) divided into Cohorts 1 (n=1,998) and 2 (n=1,999), were mostly female (66.4%) with a mean age of 84.4 years. Cohort 1 subjects were significantly older (P<0.0001) and had a lower number of comorbidities (P=0.002) compared with Cohort 2. Mean Mini-Mental State Examination (MMSE) scores in Cohorts 1 and 2 at the time of AD diagnosis or start of initial treatment were 16.9 and 17.1, respectively (P=0.2790). At 1 year, mean MMSE scores in Cohorts 1 and 2 increased to 17.9 and 17.4, respectively (P=0.1524). Donepezil was the most frequently administered medication overall (75.0%), with comparable rates between cohorts. Rates of medication persistence were ≥98% for acetylcholinesterase inhibitor or memantine therapy. Discontinuation and switch treatment rates were significantly lower (49.7% vs. 58.0%; P<0.0001), and mean duration of initial treatment significantly longer, in Cohort 2 vs. 1 (349.3 vs. 300.2 days; P<0.0001).ConclusionsComparison of cohorts before and after revision of the national LTCI system for dementia patients found no significant difference in mean MMSE scores at the time of AD diagnosis or start of initial treatment. The reduction in the proportion of patients who discontinued or changed their initial treatment, and the significant increase in mean duration of treatment, were observed following revision of the LTCI policy which enabled increased patient access to long-term care.

Prevalence and characteristics of frailty in older adults in Japan: a cross-sectional study using data from the long-term care insurance system.

[Purpose] Owing to rapid population aging, prevention of frailty in older adults and minimizing the burden on the long-term care insurance system are priorities for the Japanese government. However, limited data are available regarding the prevalence and characteristics of frailty among older adults requiring support in Japan. In this study, we investigated the prevalence and characteristics of frailty in older adults requiring support in Japan. [Participants and Methods] The study included 695 new users of preventive long-term care services certified as "requiring support" between 2011 and 2019. In this cross-sectional investigation, we used data obtained from a community comprehensive support center. Frailty prevalence was assessed using the Kihon Checklist, followed by a χ2 test. Logistic regression analysis was performed to identify the characteristics (basic information and service type) associated with frailty. [Results] A significantly large percentage of robust/pre-frail participants (72.7%) belonged to urban areas, although we observed no significant difference in robust participants with regard to residence. Furthermore, we observed significant intergroup differences in age and orthopedic conditions. [Conclusion] It is important to encourage older adults to access the long-term care insurance system and seek support at an early stage.

Technical Efficiency of Prevention Services for Functional Dependency in Japan's Public Long-term Care Insurance System: An Ecological Study.

Public long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan's public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive. We estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates. Prevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range: 0.89-0.99). These findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.

Practices and Challenges of Home Care Pressure Ulcer Management;Perception of Home-visit Nurses Who Have Completed the Specified Medical Acts Training.

This study aims to clarify practices and challenges on pressure ulcer management as perceived by home-visit nurses who have completed the specified medical acts training. We gathered 8 home-visit nurses who have completed the training in Japan. First-author conducted in-depth, semi-structured individual interviews, asking for their insights on home care pressure ulcer management. We found that the home-visit nurses conducted the following practices;[having understandings and empathy as a health care professional who engage with client's lives with developing/worsening pressure ulcer], [pressure ulcer care at its best within limited resources], [systematic advice and guidance to caregivers and other professionals], and [demonstration of nursing as the post-training nurse of the specified medical acts]. We also learn that the home-visit nurses were faced with following challenges:[difficulties in smoothly collaborating with multiple professionals from different organizations], [not reaching a high level of expertise or skill], [limitations under the long-term care and medical insurance systems] and [impact of COVID-19]. Home-visit nurses who have completed the specified medical acts training provided the nurses worked toward raising community's awareness of the care by providing leaderships to those involved in health care teams and collaborating with other professionals. J. Med. Invest. 71 : 346-355, August, 2024.

Services in public long-term care insurance in Japan.

In Japan, a public long-term care insurance system was launched in 2000. Residents can receive long-term care according to their care needs, as determined by a nationally standardized certification system. The present report describes the details of the long-term care services covered by public insurance. The Long-Term Care Insurance Act categorizes services into three major types: in-home, nursing-home, and community-based long-term care services. In-home care services include visiting, commuting, short-stay, and other services. Welfare, health, and medical facilities provide nursing-home care services for the elderly. Community-based care services were categorized into visiting, commuting, nursing-home, and composite services.

Long-term care insurance facilitating integrated care: the "whole-person, full-responsibility" system in Qingdao City of China

Introduction: The ageing of China has brought the burden of long-term care, and some local areas started the piloting of long-term care insurance (LTCI). In response to its rapid ageing situation, Qingdao was the first city in China to establish LTCI, and it became a national pilot city in 2016. Qingdao has explored an integrated LTCI system, featuring "whole-person, full-responsibility", which promotes the integration of health and long-term care service delivery.&#x0D; Short description of practice change implemented: LTCI in Qingdao is financed through a variety of channels, including the reallocation of medical insurance funds, government financial subsidies and premiums. The scope of LTCI coverage is centred on people’s needs and facilitate the provision of integrated services, including medical care, nursing care, living care, functional maintenance and spiritual comfort services. It meets the complex care needs of people with long-term disabilities, reduces the use of hospital beds, and promotes the development of the care service market.&#x0D; Targeted population and stakeholders: The targeted population is the LTCI participants in Qingdao, especially the severely disabled and dementia population. Stakeholders include medical insurance agencies, medical institutions, long-term and elderly care facilities, families, etc.&#x0D; Timeline: Qingdao has been exploring the construction of LTCI since 2012, and in 2018 it introduced the concept of ""whole-person, full-responsibility"" as a new insurance model.&#x0D; Highlights: Qingdao has innovatively established a ""whole-person, full-responsibility"" integrated insurance model facilitating the combination of medical, ageing, nursing, rehabilitation and prevention services. The core is a person-centred, integrated approach to care needs, with the same designated care provider taking full responsibility for providing the integrated services.&#x0D; The care includes ""special care"", "" institutional care"", ""home care"" and ""ambulatory care"", covering longer-term hospitalization, institutional care and home care.&#x0D; People with dementia were also reimbursed for dementia care. In addition, the Dementia Prevention Fund has been established to promote the prevention of dementia.&#x0D; Sustainability and transfer-ability: The establishment of LTCI in Qingdao has effectively reduced the use of hospital beds, reduced the burden of medical insurance funds and promoted the development of the service market. It has been scaled up to the whole province of Shandong and became a national model for LCTI with potential of large scale duplication. But the scheme still faces funding pressure as its expansion of benefits.&#x0D; Conclusion: LTCI in Qingdao is based on the concept of ""whole-person, full-responsibility"", taking into account the care needs of people in a holistic manner, which addresses the care integration for long-term disabled and dementia population. It also promoted the development and capacity building of providers and reduced the burden of medical system, resulting in a win-win situation for all parties. It provided a model for China to explore the LTCI system and integrated care for the elderly.&#x0D; Discussion: To promote the sustainable development of Qingdao's LTCI system as well as the national LTCI system, issues should be considered in the next step including the sustainable fund raising through diversified channels, the supervision of service quality, training of professionals and workforce, and priority given to disability prevention.

DEMENTIA PREVENTION: THE COST-EFFECTIVENESS OF PREVENTION SERVICES IN JAPANESE LONG-TERM CARE SYSTEM

Abstract Objectives To analyze the cost-effectiveness of prevention services (Named “Support” in Japanese official documents) in Japanese Long-Term Care Insurance system, which draws data from a large volume of 10-year database in Osaka Prefecture. Design: We design an approach to estimate cost-effective prices using aggregate data including costs of dementia in 10 years, time of dementia first diagnosed, changes of care levels, and quality of life. Measurements: The outcomes were average annual expenditure per unit of services. Results In higher risk groups of dementia, prevention services delaying cognitive decline and enhancing quality of life were cost effective at $206 per individual. However, this cost-effectiveness will wear off as symptoms worsen and the care levels increase. Conclusion Prevention services from Long-Term Care Insurance system are possibly to be cost-effective, but this cost benefit is not long-term .

GROWING OLD IN CHINA: SYSTEMATIC REVIEW OF LONG-TERM CARE INSURANCE PILOT STUDIES

Abstract Between 1970 and 2020, there was a three-fold increase in China’s ≥65 population, compared to less than a doubling in UK. This rapid-ageing demographic has led to a rise in age-related disabilities. At the same time, internal migration and declining fertility have shaken traditional models of care. An important policy response is to pilot differing long-term care insurance (LTCI) systems, with the aim of establishing equitable care for all. Strengths and limitations of the first set of pilot studies have been identified. In 2020, a second set of 34 pilot studies was introduced. Following PRISMA guidelines, we undertook a systematic review of literature published since introduction of the second pilot phase, to answer the question: ‘what are the key challenges to China achieving an equitable nationwide long-term care system for older people?’. Records were eligible for inclusion if published between June 2020 and June 2022 in Mandarin or English. 42 studies (n=16 Mandarin) were included. Four themes emerged: poor quality of service provision, widespread preference for family care, inequitable distribution of cost burden, and varying LTCI eligibility. Key recommendations included increasing salaries to attract and retain staff, mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart care capacity can support preferences to age at home. Our systematic review highlighted significant challenges in provision of equitable care which suits preferences of its users. China’s LTCI pilots will provide useful lessons for other middle-income countries with rapidly ageing populations.

Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care.

Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care. The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs. Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001). Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumferenceis suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.

Protective effects of dog ownership against the onset of disabling dementia in older community-dwelling Japanese: A longitudinal study

This prospective study examined the associations of dog/cat ownership with incident disabling dementia using propensity score matching based on the physical, social, and psychological characteristics of dog and cat owners. We also examined associations of the interaction between dog/cat ownership and exercise habit and social isolation with dementia. Overall, 11,194 older adults selected using stratified and random sampling strategies in 2016 were analyzed. Dog/cat ownership was defined as “current” or “past and never”. Disabling dementia was defined according to physicians’ rating in the long-term care insurance system in Japan during the approximately 4-year follow-up period. Statistical analysis was weighted by the inverse of the propensity score in the generalized estimating equation after adjusting for follow-up period. Current dog owners (8.6 %) had an odds ratio (OR) of 0.60 (95 %CI: 0.37–0.977) of having disabling dementia compared to past and never owners. For cat ownership, the corresponding OR was 0.98 (95 %CI: 0.62–1.55). Current dog owners with a regular exercise habit had an OR of 0.37 (0.20–0.68) compared to past and never dog owners with no exercise habit. Further, current dog owners with no social isolation had an OR of 0.41 (0.23–0.73) compared to past and never dog owners with social isolation. Dog ownership had a suppressive effect on incident disabling dementia after adjusting for background factors over a 4-year follow-up period. Specifically, dog owners with an exercise habit and no social isolation had a significantly lower risk of disabling dementia.

Influence of medical care tasks on subjective burden and gain among older adults’ family caregivers: structural equation modeling for testing the role of formal and informal support

BackgroundThe number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers’ appraisals of caregiving differed based on the support received.MethodsInterview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan’s long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses.ResultsApproximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients’ physical and cognitive difficulties; caregivers’ age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers’ sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain.ConclusionsThese results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.

The relationship between working status in old age and cause-specific disability in Japanese community-dwelling older adults with or without frailty: A 3.6-year prospective study.

To examine the effects of employment engagement, classified by frailty and working status, on the incidence of disability in urban community-dwelling older adults. We used data from 6386 initially nondisabled residents aged 65-84 years from Ota City, Tokyo, Japan, in 2016. The observation duration was 3.6 years. Self-administered questionnaires applied the Cox proportional hazard model by assessing the existence of frailty through Check-List 15 (with a score ≥4 indicating the state of frailty), controlling for age, sex, living situation, education level, equivalent income, chronic conditions, body mass index, instrumental activities of daily living, self-rated health, drinking and smoking status, and social activities. We evaluated the predictive value of working status (full-time, part-time, temporary, or nonworker) at baseline for cause-specific disability (dementia-type vs. non-dementia-type) incidence, identified using the long-term care insurance system's nationally unified database. Of the 6386 participants, 806 (63/1134 full-time workers; 58/1001 part-time workers; 61/547 temporary workers; 624/3704 nonworkers) presented with disabilities during the 3.6-year-long duration. Adjustments for conventional covariates showed that nonfrail full-time and part-time workers, as well as frail full-time workers, had significantly lower risks of all-cause disability incidence. Furthermore, nonfrail and frail full-time workers had significantly lower risks of dementia-type and nondementia-type disabilities, respectively. The incidence of disability in older adults was influenced by working and frailty status. Engaging in full-time work thus prevents disabilities in older adults, regardless of their frailty status. Meanwhile, nonfrail older adults are able to avoid disabilities even when engaging in part-time work. Geriatr Gerontol Int 2023; 23: 855-863.

Rapid weight change as a predictor of disability among community-dwelling Japanese older adults.

To fill the knowledge gap regarding weight change and the onset of disability in community-dwelling Japanese older adults, we investigated the potential effects of rapid weight change on disability risk as defined by Japan's long-term care insurance (LTCI) system. We analyzed data from a longitudinal study of 10 375 community-dwelling older Japanese adults (≥65 years) who were not LTCI needs certified at baseline and joined the study from 2002 to 2005. Weight change (percentage) was calculated by subtracting participants' weight in the previous year from that measured during a physical examination at study commencement. The five weight-change categories ranged from sizable weight loss (≤ -8.0%) to sizable weight gain (≥ +8.0%). Disability was defined according to LTCI certifications at follow-up. Hazard ratios (HRs) and 95% confidence intervals were calculated for new-onset disability using a Cox proportional hazards model that fitted the proportional subdistribution hazards regression model with weights for competing risks of death. During the mean 10.5-year follow-up, 2994 participants developed a disability. Sizable weight loss (HR [95% confidence intervals], 1.41 [1.17-1.71]) and weight loss (1.20 [1.05-1.36]) were significant predictors of disability onset. Sizable weight gain (1.45 [1.07-1.97]) corresponded to severe disability. Stratified analyses by lifestyle and initial body mass index categories revealed more pronounced associations between weight change and disability risk in the unhealthy lifestyle and below initial normal body mass index groups. Rapid and sizable weight gain could be additional criteria for disability risk in older adults. Geriatr Gerontol Int 2023; 23: 809-816.