Long-term Care Insurance System Research Articles

Perceived Level of Life Enjoyment and Risk of Developing Disabling Dementia: The Japan Public Health Center-Based Study.

Life enjoyment, linked to the ability to engage pleasurably with one's environment, may be related to the risk of developing dementia. This prospective cohort study examined the association between level of life enjoyment and disabling dementia incidence among Japanese community residents. The participants were Japanese, aged 45-74 years old at 5-years follow-up, in the Japan Public Health Center-based Study (N = 38,660). Psychological conditions and other confounding variables were identified through self-administered questionnaires. Incident disabling dementia registered based on the Japan's Long-Term Care Insurance system from 2006 to 2016. Hazard ratios [95% confidence intervals] were assessed using Cox proportional hazards models. Over a median follow-up period of 9.4 years, a total of 4,642 cases of disabling dementia developed. Level of life enjoyment was inversely associated with the risk of disabling dementia: the multivariable hazard ratios were 0.75 [0.67-0.84] (p < .001) and 0.68 [0.59-0.78] (p < .001) with medium and high life enjoyment, respectively, compared to low life enjoyment. Furthermore, the association between greater life enjoyment and low risk for disabling dementia was strongest in the subgroup with low-medium mental stress. In the high mental stress group, this association was evident for poststroke disabling dementia, but not for disabling dementia without a history of stroke. A higher level of life enjoyment was associated with a lower risk of disabling dementia, particularly in the low-medium mental stress group. This finding suggests the importance of having life enjoyment by managing mental stress for reducing risk of disabling dementia.

Analysis of Nursing Needs of the Elderly with Disability and Dementia in Rural Areas of Anqing City under the Theory of Social Support

After the new century, the aging of the population, the aging of the population and the longevity of multiple health states are accelerating, and the long-term care of the elderly with disability and dementia is becoming increasingly prominent. China began the pilot of long-term care insurance in 2016, covering about 169 million people by the end of 2022, and home care is the first choice for most elderly families with disabilities and dementia. As the only pilot city in the province, Anqing currently guarantees the moderate and severe disability groups of urban workers, and does not cover other urban and rural disabled and semi-disabled residents, nor does it include the elderly with dementia, it is necessary to analyze the long-term care needs of these families. This paper uses comparative analysis to compare and analyze the implementation mode of long-term care insurance in Shanghai, Qingdao and Nantong, and finds the problems in the pilot process through comparative analysis, in order to provide reference for the improvement of long-term care insurance system in Anqing.

Research on long-term care insurance system under the concept of continuity nursing

Research on long-term care insurance system under the concept of continuity nursing

Five-year changes of social activity and incident long-term care needs among depressed older adults: A 15-year follow up

ObjectivesTo examine the effects of changes in individual/multiple social activities between 65 and 70 years of age on incident long-term care (LTC) needs between 70 and 80 in older adults with depressive symptoms. MethodsParticipants were recruited from the New Integrated Suburban Seniority Investigation Project, an ongoing prospective cohort study. A total of 525 older adults with depressive symptoms were included. The validated 15-item Geriatric Depression Scale was used to assess depressive symptoms. A self-report questionnaire was used to measure social activities (social-related, learning, and personal). LTC needs was defined according to Japan's Long-term Care Insurance System. A competing risk model and a Laplace regression model were used to estimate the hazard ratios of LTC needs incidence and the 25th percentile difference in LTC-needs-free survival time and their 95% confidence intervals. ResultsOut of 4314 person-years of mild LTC needs, 108 individuals developed it. Participants who increased their frequency of learning activities have a lower risk of developing mild LTC needs. Increasing the frequency could also prolong LTC-needs-free survival time by approximately 2.61 years. Out of 4535 person-years for severe LTC needs, 54 individuals developed it. Participants with a continuous regular frequency of learning activities had a lower risk of developing severe LTC needs. However, the association between this frequency and LTC-needs-free survival time for severe LTC needs was insignificant in the multivariable models. ConclusionsIncreased frequency of learning activities reduced the risk of LTC needs among older adults with depressive symptoms and prolonged their LTC-needs-free survival time.

Sarcopenic Obesity and Risk of Disability in Community-Dwelling Japanese Older Adults: A 5-Year Longitudinal Study.

Previous studies have indicated that sarcopenic obesity is a risk factor for disability onset. However, these studies had disparities in terms of criteria for sarcopenia, study design, or study population. No longitudinal study has investigated the effect of sarcopenic obesity on disability onset in an Asian population using the Asian Working Group for Sarcopenia 2019 criteria for sarcopenia definition. Herein, we aimed to investigate the longitudinal effect of sarcopenic obesity on disability onset in Japanese older adults and extend the generalizability of results to other populations. Longitudinal cohort study. A total of 4197 Japanese older adults (mean age 74.6 ± 5.0years, 54.2% women) formed our study population. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 algorithm. Obesity was determined when body fat percentage was ≥25%, or when visceral fat content was ≥100cm2 for either sex. Disability onset was defined as a new case of long-term care insurance system certification for 5 years from baseline. Missing values were managed with multi-imputation. Cox proportional hazard regression analysis was used with disability onset as dependent variable and group (nonsarcopenia/nonobesity as a reference, nonsarcopenia/obesity, sarcopenia/non-obesity, possible sarcopenia/obesity, possible sarcopenia/non-obesity, sarcopenic obesity) as explanatory variable, and was adjusted for potential confounding factors. When the nonsarcopenia/nonobesity group was used as the reference category, other groups such as possible-sarcopenia/nonobesity [hazard ratio (HR) 1.38, 95% confidential interval (95% CI) 1.29‒1.47, P < .028], possible-sarcopenia/obesity (HR 1.54, 95% CI 1.46‒1.62 P < .001), sarcopenia/nonobesity (HR 2.09, 95% CI 1.96‒2.23, P < .001), and sarcopenic obesity (HR 2.48, 95% CI 2.24‒2.75, P < .001) showed significantly increased HRs. The risk of disability onset because of sarcopenic obesity was exceedingly higher compared with sarcopenia alone among community-dwelling older adults in Japan The health providers should consider assessing the co-existence of sarcopenia and obesity to screen for the risk of disability onset in the community-dwelling population.

Accelerometer-measured sedentary behavior and risk of functional disability in older Japanese adults: a 9-year prospective cohort study

BackgroundThe associations of sedentary time and patterns with functional disability among older adults remain unclear, and few studies have accounted for the co-dependency of sedentary behavior and physical activities when modeling sedentary behavior with risk of functional disability. We aimed to examine the associations between sedentary time and patterns and risk of incident functional disability, and assess whether replacing sedentary time with light physical activity (LPA) or moderate-to-vigorous intensity physical activity (MVPA) is associated with reduced risk of functional disability in community-dwelling older adults.MethodsA total of 1,687 Japanese adults aged ≥ 65 years without functional disability at baseline were prospectively followed-up for 9 years (2011–2020). Functional disability was ascertained using the national database of Japan’s Long-term Care Insurance System. Sedentary time and patterns, LPA, and MVPA were measured using a tri-axial accelerometer secured to participants’ waists.ResultsDuring follow-up, 466 participants developed functional disability. Compared with the lowest quartile of total sedentary time, the multivariable-adjusted hazard ratios (95% confidence intervals) of functional disability for the second, third, and top quartiles were 1.21 (0.91‒1.62), 1.45 (1.10‒1.92), and 1.40 (1.05‒1.88) (p for trend = 0.01). After further adjusting for MVPA, total sedentary time was no longer significantly associated with the risk of functional disability (p for trend = 0.41). Replacing 10 min/day of sedentary time with the same amount of MVPA (but not LPA) was significantly associated with a 12% reduced risk of functional disability (hazard ratio [95% confidence interval]: 0.88 [0.84‒0.92]). No significant association was observed between sedentary bout length and functional disability.ConclusionHigher levels of total sedentary time were associated with an increased risk of incident functional disability. However, this association was not independent of MVPA. Replacing sedentary time with MVPA, but not LPA, was associated with reduced risk of functional disability in older adults.

Relationship between Total Kihon Checklist Score and Age-Specific Deaths among Late-Stage Older Adults in Otawara City (Aged 75 and Older) over a 15-Year Period

Introduction: While the Japanese long-term care insurance system supports an ageing society, there are concerns about the shortage of financial resources and labour force. Further, extending healthy life expectancy and narrowing the gap with the average life expectancy are important issues. In this study, we aimed to examine, over a 15-year period, the relationship between the total Kihon Checklist (t-KCL) score and age-specific deaths among late-stage older adults aged 75 and older who were not certified for long-term care insurance. Methods: The participants were older adults residing in Otawara City, Tochigi Prefecture, who were aged 75 years or older as of 2006. The participants, who were not certified by the long-term care insurance system, were asked to complete the KCL by a community welfare committee member. Based on their t-KCL scores, the participants were classified as robust (0–3 points), pre-frail (4–7 points), and frail (≥8 points). The deaths of those aged 75–89 years who had completed the KCL were investigated. Information on deaths was obtained from local authorities. Statistics were examined for the risk of robust, pre-frail, and frail mortality using a Cox proportional hazards model with age and gender as covariates for the 75–79, 80–84, and 85–89 age groups. Results: Of the 7,924 participants, 3,423 (75–79 years: 1,990, 80–84 years: 1,059, 85–89 years: 374) were ultimately eligible for the study. Of these, 2,450 (75–79 years: 1,238, 80–84 years: 861, 85–89 years: 351) died over the 15-year study period. Hazard ratios for death in frailty as determined by the t-KCL score were 1.337 (95% confidence interval [CI], 1.162–1.540) for the pre-frail group and 2.012 (95% CI, 1.7756–2.305) for the frail group at 75–79 years, respectively, compared with the robust group; 1.511 (95% CI, 1.271–1.797) at 80–84 years only in the frail group; and 1.567 (95% CI, 1.140–2.154) at 85–89 years, also in the frail group. Discussion: The relationship between frailty and mortality weakens after age 80. The results suggest that factors other than frailty may have a stronger influence on mortality risk after the age of 80.

From the Perspective of Internal Control, Research on the Government Responsibility for the Construction of Long Term Care Insurance System in China

Under the pressure of aging, aging of the aged, disability, empty nesting and so on, the demand for long-term care services for the elderly in China has risen sharply. To explore and establish a social long-term care insurance system is conducive to meeting the needs of the elderly for long-term care services. This paper demonstrates the necessity of government responsibility in the social long-term care insurance system, discusses the advantages and disadvantages of different government responsibility modes and the choice of government responsibility modes, and analyzes in depth the implementation of government responsibility. Specific contents.

Effect of China's Long-term Care Insurance on Health Outcomes of Older Disabled People: Role of Institutional Care.

Since the public long-term care insurance (LTCI) system was piloted in Chengdu, China in October 2017, there has been a considerable growth of LTC institutions in China. This study aimed to evaluate the health value effect of LTCI in older patients with severe disabilities in an LTC institution. This prospective study was based on data from 985 severe disability patients with or without LTCI from October 2017 to May 2021 in the Eighth People's Hospital, Chengdu, China. The Cox proportional hazard model estimated LTCI's health value, including survival probability and risk of pneumonia/pressure ulcers. Subgroup analysis was performed for sex, age, Charlson Comorbidity Index (CCI), and the number of drugs. In the analysis 519 and 466 patients in LTCI and non-LTCI groups, respectively, were included. In adjusted Cox analyses, the LTCI group had a significantly elevated survival rate compared with the non-LTCI groups at 12 months (P<0.001, HR=1.758, 95% CI 1.300-2.376). At 40 months, the adjusted survival rate was 62.6% in the LTCI group, which was significantly higher (53.7%; P=0.003, HR=1.438, 95% CI 1.131-1.831). The subgroups of patients aged 60 to 79 years (interaction P=0.007) and CCI≥3 (interaction P=0.026) were more significantly associated with survival improvement than those aged >80 years and CCI< 3. The LTCI group was also at lower risk for hospital-acquired pneumonia (P=0.016, HR 0.622, 95% CI 0.422-0.917) and pressure ulcers (P=0.008, HR 0.695, 95% CI 0.376-0.862). The improved survival of LTCI remained stable in sensitivity analyses. For older patients with severe disabilities, in a long-term care institution, LTCI significantly improved their health profile and longevity after a year, suggesting the large role and development potentiality of institution care in the LTCI system of China.

Combined impacts of physical activity, dietary variety, and social interaction on incident functional disability in older Japanese adults.

This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults. Participants were 7,822 initially non-disabled residents (3,966 men; 3,856 women) aged 65-84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system's nationally unified database. During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (0.59-0.78), 0.87 (0.77-0.99), and 0.91 (0.79-1.03), respectively. Incident disability HRs (95% CIs) gradually reduced with increased frequency of satisfying these behaviors (any one: 0.82, 0.65-1.03; any two: 0.65, 0.52-0.82; and all three behaviors: 0.54, 0.43-0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (-0.2, 7.9), 9.6% (4.8-14.1), and 16.0% (8.7-22.8), respectively. Combining active physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Adding the insufficient behavior element to individual habits and preexisting social group activities may be effective in preventing disability in the community.

Building a welfare system through bounded learning: A case of Korean long‐term care insurance

AbstractThis article verifies three conditions in its aim to confirm the influence of Japan's experience on the introduction timing and policy model of South Korean long‐term care insurance (LTCI). First, the LTCI systems in Korea and Japan agree in terms of their core principles. Both are based on a separate social insurance system and ensure financial sustainability at the expense of service quality in response to the need to elevate expenditure. Second, the policymaking process reveals the reference relationship between the two systems. The advocacy coalition for LTCI suggested introducing an LTCI based on Japan's experience. However, their rationale was constrained due to the bounded rationality of policy learning. Finally, this article demonstrates that the rival arguments cannot completely explain the introduction of the Korean LTCI without considering the bounded learning argument. Consequently, the results of this study indicate that policy learning is critical to welfare development in latecomer welfare states.

Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people

BackgroundFrom 2020 to 2050, China’s population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer’s disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country.MethodsUsing official and population-level statistics, we summarise China’s demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China’s improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: ‘what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?’. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China’s second long-term care insurance pilot phase in 2020.ResultsRapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home.ConclusionsChina has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

The impact of long-term care insurance system on family care: Evidence from China.

The inconsistent findings on the impact of the long-term care insurance (LTCI) system on family care require us to extend our study horizon to more countries with LTCI system designs or market practices. China has explored the LTCI system through pilot programs, which provide a quasi-natural experimental environment. This paper aims to examine how the LTCI system affects family care in China. We primarily employ the time-varying difference-in-differences method to perform regression analyses based on the panel data from the China Health and Retirement Longitudinal Study. We discover a 7.2% rise in family care under the LTCI system. Specifically, the LTCI system is more likely to promote family care as the relatively primary care for disabled women, disabled people aged 60-74, and those who cannot fully take care of themselves. In addition, the formal care support policy of LTCI will crowd in both formal care and family care, and the crowding-in-effect on formal care may even obscure the crowding-in-effect on family care. The family care support policy of LTCI may encourage the policy-covered groups to take family care as their relatively primary care. It may also lengthen family care for those groups. The LTCI system has a crowding-in effect on family care. It can increase family care through cash payments or linking formal and informal care resources by providing formal community and home care.

Serum folate and risk of disabling dementia: a community-based nested case–control study

ABSTRACT Purpose The aim of this study was to examine associations between serum folate levels and risk of disabling dementia that required care under the national insurance (disabling dementia). Methods We performed a nested case–control study in a community-based cohort, the Circulatory Risk in Communities Study, involving 13,934 Japanese individuals aged 40–84 years at the baseline period of 1984–2005. Serum folate was measured in 578 cases of incident disabling dementia, and in 1,156 controls whose age (±1 years), sex, area of residence, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. Results After a 20.8-year follow-up, serum folate was inversely associated with risk of disabling dementia. The respective multivariable odds ratios (95% CIs) were 0.71 (0.51–0.99), 0.76 (0.54–1.06), 0.70 (0.49–1.00), and 0.62 (0.43–0.90) for persons with the second, third, fourth, and highest quintiles of serum folate as compared with the lowest quintile (P for trend = 0.03). A similar association was observed for dementia with or without stroke. Conclusion In this nested case–control study with a long follow-up, low serum folate levels were associated with an increased risk of disabling dementia among Japanese individuals.

A Review of the Implementation of the Long-term Care Insurance System in China - A Case Study of City T

A Review of the Implementation of the Long-term Care Insurance System in China - A Case Study of City T

Association between community-level health literacy and frailty in community-dwelling older adults.

We aimed to investigate whether high community-level health literacy, beyond individual-level health literacy, is associated with a low prevalence of frailty among community-dwelling older adults. A large cross-sectional questionnaire survey was conducted among citizens in Maizuru City, Kyoto, Japan, aged 65years or older who were not certified as "support" or "care" level according to Japan's public long-term care insurance system, who could perform basic activities of daily living, and who did not have dementia or Parkinson's disease. Frailty status was assessed using the Kihon Checklist, with a score ≥ 8 indicating frailty. Health literacy was assessed using the Communicative and Critical Health Literacy Scale. The mean health literacy score of 20 school districts was used as the community-level health literacy index. We investigated demographic data and other potential confounding factors, including education, living arrangement, body mass index, comorbidity, smoking status, depressive symptoms, social networks, and community-level covariates. The primary analysis included 6230 individuals (mean age = 74.3years [SD = 6.1]). In each school district, the prevalence of frailty was 21.2-34.2% (mean: 26.2%), and community-level health literacy index was 3.1-3.5 (mean: 3.4). Multilevel logistic regression model including school district as random effect showed that the community-level health literacy was significantly associated with frailty (odds ratio [95% confidence interval] = 0.28 [0.08 to 0.96]) after adjusting for the covariates. Not only high individual-level health literacy but also high community-level health literacy is associated with a low prevalence of frailty in community-dwelling older adults.

Leg skeletal muscle mass asymmetry is independently associated with gait speed in older adults requiring long-term care.

Decreased gait speed in older adults has been associated with incident disability, cognitive impairment, institutionalization, falls, deterioration in level of care, and mortality. Gait speed has been reported to be related to leg asymmetry. However, the relationship between gait speed and leg skeletal muscle mass asymmetry in older adults requiring long-term care has not been clarified. In this study, we examined the association between gait speed and leg skeletal muscle mass asymmetry and the cutoff values of leg skeletal muscle mass asymmetry that may affect gait speed. The asymmetry index of leg skeletal muscle mass was measured in 230 older adults under the Japanese long-term care insurance system using bioelectrical impedance analysis. This cross-sectional study used multiple regression analysis and receiver operating characteristic (ROC) curve analysis to determine the relationship between gait speed and the asymmetry index of leg skeletal muscle mass. Multiple regression analysis revealed that the asymmetry index of leg skeletal muscle mass (β = -0.19, P = 0.002, R2 = 0.261) was independently and significantly associated with gait speed. Furthermore, ROC analysis showed that the cutoff value of the asymmetry index of leg skeletal muscle mass that identified reduced gait speed (<1.0 m/s) was 3.02% (Area under the curve = 0.62, sensitivity 47.3%, specificity 81.0%, P = 0.014). The asymmetry index of leg skeletal muscle mass was associated with gait speed in older adults requiring long-term care. Future assessment and interventions directed towards symmetry of leg skeletal muscle mass may help to improve gait speed in older adults. Geriatr Gerontol Int 2023; 23: 371-375.

Web-Based Questionnaire Survey on Heart Failure in Elderly Patients Using Outpatient Rehabilitation - Actual Conditions of Cardiac Rehabilitation in Long-Term Care Insurance Systems.

Background: The purpose of this study was to investigate the actual conditions of cardiac rehabilitation (CR) for elderly patients with heart failure (HF) in outpatient rehabilitation (OR) facilities using long-term care insurance systems. Methods and Results: This was a cross-sectional web-based questionnaire survey conducted at 1,258 facilities in the Kansai region (6 prefectures) of Japan from October to December 2021. In all, 184 facilities responded to the web-based questionnaire (response rate 14.8%). Of these facilities, 159 (86.4%) accepted patients with HF. Among the patients with HF, 94.3% were aged ≥75 years and 66.7% were classified as New York Heart Association functional class I/II. Facilities treating patients with HF generally provided exercise therapy, patient education, and disease management, which were components of CR. Many facilities not currently treating patients with HF responded positively stating they will accept HF patients in the future. However, a few facilities responded by stating that they are waiting for clearer evidence demonstrating the beneficial effect of OR on patients with HF. Conclusions: The present results show the possibility that outpatient CR can be performed for elderly patients with HF in other than medical insurance.

Diffusion Mechanism of China’s Long-term Care Insurance System—An Empirical Analysis Based on 31 Provinces

ABSTRACT A long-term care insurance system provides basic living assistance, medical care cost compensation, and service assurance for people with disabilities. In China, it was first piloted in Qingdao, Shandong Province, in 2012, and has now been implemented in 27 provinces as pilot areas. The locally started policy was adopted by the central government and extended to the whole country in eight years. We focus on answering two questions: How did the diffusion of the policy occur? What were its determining factors? Based on the perspective of policy innovation and diffusion, this study empirically analyzes the main factors influencing the diffusion of the long-term care insurance system using a Cox proportional-hazards model and data from 31 Chinese provinces. The study found that the main internal factors were the local aging coefficient and degree of socioeconomic development, and the main external factors were national competition pressure and central policy pressure.

Analysis of Demand for Long-Term Care Insurance in Wenzhou

In the context of the accelerated aging of Chinese society and the requirements of the Central Economic Work Conference to prevent major risks, this paper explores the long-term care insurance system of Wenzhou based on the data of the seventh census of Wenzhou in 2020, and analyzes the scale of the disabled elderly in Wenzhou, and thus derives the future demand for long-term care, and designs the corresponding contribution scheme while predicting the future cost of long-term care.