Public Long-term Care Insurance Research Articles

Does income matter for the policy effect of public long-term care insurance on informal care use in China? A quasi-experimental study.

Since 2016, the Chinese government has been piloting a public long-term care insurance (LTCI) scheme. This study examined whether the LTCI scheme reduced the use of informal care and how this has varied across income groups. We used data from the 2011, 2014, and 2018 waves of Chinese Longitudinal Healthy Longevity Survey, focusing on community-dwelling older adults aged 65 years and older. We used staggered difference-in-differences analyses with propensity score matching to examine the effects of the policy. The LTCI scheme reduced the probability and intensity of informal care use by 5.7% (p < .05) and 17.4% (p < .05), respectively. The policy impact was limited to older people in the middle-income group, reducing the probability and intensity of informal care use by 15.6% (p < .001) and 43.1% (p < .05), respectively. We did not find a statistically significant policy effect for older adults with high or low incomes. The LTCI scheme had different effects on reducing the informal care burden for family caregivers by income level. We suggest that the scheme should entitle people with low incomes to a preferential co-payment rate, thereby enhancing their access to formal care.

Long-run consequences of informal elderly care and implications of public long-term care insurance

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany’s public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

Complements or Substitutes? Young Germans’ Experience and Expectations with Financing Sources for Long-Term Care

ABSTRACT Financing long-term care is a growing challenge in aging societies. To address this challenge, Germany created public long-term care insurance (DPV) more than 25 years ago. Germans still need to prepare for their own care throughout their life course to supplement public insurance. This study presents descriptive statistics and multivariate regression analysis to examine young Germans’ experiences and expectations of the relationship between the DPV and private financing sources. We base our analysis on a proprietary data set of young Germans (16–39 years old) that oversamples those with caregiving experience and East Germans. We find that public long-term care insurance is a substitute for rather than a complement to other financing sources. Specifically, many young Germans do not count on public long-term care insurance to finance care. Instead, they see private funding sources as substitutes for long-term care insurance. Those who count on private long-term care insurance are between 48 and 70% less likely to count on DPV benefits. Experience with care increases the likelihood of young Germans expecting future public benefits by factor of six or 18, depending on the specific care familiarity. Young Germans are also more likely to count on future generations to support their own care than they expect themselves to support the care of their parents through the DPV. Given that the DPV provides basic universal insurance that requires some complementary private income sources, our findings suggest that young Germans, who will need to build some of these income sources throughout their careers, are underestimating the value of the DPV and overestimating their own ability to pay for long-term care. Policymakers will need to reduce the political risks to the DPV and increase young Germans’ savings over the life-course to address this imbalance.

The impact of reducing formal care benefits on caregivers’ well-being: evidence from Japan

AbstractThis study examines the impact of reducing formal care benefits on the well-being of informal caregivers, contributing to the ongoing discourse about establishing sustainable and adequate levels of formal care. We utilize a reform introduced in Japan’s public long-term care insurance system, which curtailed formal care benefits for a group of recipients with low care needs. Employing a difference-in-difference approach with fixed effects on a nationally representative sample of coresident informal caregivers, we explore both the overall and temporal effects of this reform. Our findings reveal that the reform had an adverse impact on caregivers’ physical well-being, leading to diminished mobility and stability. The impact on caregivers’ mental well-being was less clear, reflecting a competing influence of stress and the psychological rewards associated with caregiving. The decline in physical well-being endured over time, while the effects on mental well-being were transient. Additionally, female caregivers exhibited greater vulnerability compared to their male counterparts, experiencing more significant deterioration in both physical and mental well-being. Alarmingly, the reform also negatively influenced the well-being of care recipients, suggesting that reducing formal care benefits does not yield positive outcomes for either caregivers or recipients. This study underscores the necessity of accounting for caregivers’ well-being when evaluating the cost-effectiveness of reducing formal care benefits and advocates for policies aimed at safeguarding female caregivers from health and financial challenges.

Current Status of Public Long-term Care Insurance Services and Future Perspective: A Questionnaire Survey and National Health Insurance Service Data of South Korea

The continuing growth of population aged 65 years and above, the socioeconomic burden of long-term care insurance has consistently increased. This study aimed to review the current system and efficiently develop long-term care insurance services according to changes in socioeconomic situations. First, a 21 items questionnaire survey was conducted from August 16 to August 31, 2022, for all members of the Korean Neurological Association. The survey was divided into seven areas, and individualized results were analyzed. Second, cumulative data on long-term care insurance services were collected and analyzed from July 1, 2008 to December 31, 2021, for the National Health Insurance system, and the results were summarized. In the survey, approximately 21% of the neurologists answered a web-based questionnaire survey on current doctors’ referral slips for long-term insurance services. Most (94%) had doctor referral slips for long-term insurance services. However, the authors estimated that doctors’ referral slips did not sufficiently affect the grading of longterm insurance services. The long-term care insurance services data according to several categories were classified and then, we statistically analyzed the socioeconomic burden of long-term insurance. Those cumulative data showed a gradual increase in the recipient number, diversity of geriatric diseases, and socioeconomic burden. We suggested that it is necessary for the government and academic society to continue to cooperate to develop the long-term care insurance systems for elderly.

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.

Longitudinal association between frequency of Internet use and incident disability among community-dwelling older people during the COVID-19 pandemic.

There is limited evidence of a protective effect of Internet use for incident disability (ID) during the COVID-19 pandemic. We investigated the association between frequency of Internet use (FIU) and ID among community-dwelling older people. We used longitudinal data from the 2019 and 2022 surveys, including 7,913 residents aged ≥65 without disability at baseline. ID was defined as a new public long-term care insurance certification. FIU at baseline was categorized into daily, weekly, monthly, yearly, and non-users. Changes in FIU before and during the COVID-19 pandemic were categorized into continuing frequent (i.e., daily or weekly), continuing moderate (i.e., monthly or yearly), increase in frequency, from non-users to users, decrease in frequency, from users to non-users, and continuing non-users. Covariates included age, gender, education, perceived economic situation, family structure, body mass index, chronic medical conditions, dietary variety, working status, walking time, and cognitive functioning. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (aCIR) and 95% confidence interval (CI) for ID. During the 3-year follow-up, 132 of 4,453 people aged 65-74, 595 of 3,460 people aged ≥75, 287 of 3,660 men, and 440 of 4,253 women developed ID. For FIU at baseline, among people aged ≥75 or men, there was a dose-response relationship between more frequent Internet use at baseline and a lower risk of ID (P-trend was 0.005 in people aged ≥75, and <0.001 in men). Compared to non-users, daily users had a significantly lower risk of ID [aCIR (95% CI) = 0.69 (0.53-0.90) in people aged ≥75, and 0.49 (0.34-0.70) in men]. For changes in FIU, "continuing frequent" and "from non-users to users" had a lower risk of ID than continuing non-users. After stratified analyses, "continuing frequent" remained a significant association in people aged ≥75 or in men, while "from non-users to users" had a significant association in those with daily walking time <30 minutes. Although FIU may act as a marker of disability, or indicate individual adaptability, our findings suggest that Internet use may be a potential preventive measure against ID in community-dwelling older people when social distancing is required.

Typologies of dependency, household characteristics, and disparity in formal and informal care use: analysis of community-dwelling long-term care insurance claimants in an urban municipality of China

BackgroundA comprehensive understanding of subgroups of community-dwelling older adults and their long-term care (LTC) utilization can help to promote equality in the long-term services and support system. Dependency and household characteristics were found to affect the LTC utilization of homebound older adults. However, few studies considered the typologies of dependency of older populations according to co-occurring limitations, and little is known about differences in LTC use among elderly of typologies of dependency under distinct household conditions.MethodsWe aimed to identify typologies of dependency of older adults living at home and explore the disparities in formal care and informal care use among typologies of dependency by income and living situation. In this cross-sectional study, we used the public long-term care insurance (LTCI) database of Yiwu, Zhejiang Province, China, and included 1675 individuals aged ≥ 60 years living at home. Cluster analysis was conducted to determine typologies of dependency among older adults. A two-step multilevel analysis was used to examine disparities in formal and informal care use related to household income and living status among typologies of dependency.ResultsSeven dependency clusters were identified. Pro-wealthy inequalities in both formal and informal care use were found in the least dependent cluster and the limited-locomotion cluster. Pro-poor inequalities in formal care use were found in the fully dependent cluster without impaired vision and the cluster with intact continence and vision. Living with family members was positively associated with receiving formal care for the fully dependent cluster. Older adults in most clusters were more likely to use informal care when living with family members, except for the least dependent cluster and the limited-locomotion cluster.ConclusionsOur findings suggest that household inequalities in LTC use varied among typologies of dependency of older adults, which may provide insights for researchers and policymakers to develop tailored LTC and targeted LTCI programs for older adults living at home and their family caregivers, considering both typologies of dependency and household characteristics.

Association of community-level social capital with dementia: A multilevel nine-year longitudinal study using data from the Japan Gerontological Evaluation Study

BackgroundIndividual-level social capital prevents cognitive decline. However, a few studies have focused on the effects of community-level social capital on dementia. Therefore, we investigated the association between community-level social capital and dementia onset based on longitudinal study data on older adults in Japan. MethodsWe used longitudinal data from the Japan Gerontological Evaluation Study, obtained over nine years (2010–2019). In total, 35,921 physically and cognitively independent individuals (16,848 males and 19,073 females) aged ≥65 years and nested within 308 communities in seven municipalities participated in the study. Dementia onset was assessed using the public long-term care insurance registration. Social capital was assessed using three dimensions: civic participation, social cohesion, and reciprocity. We performed a two-level multilevel survival analysis stratified by sex, calculated hazard ratios (HRs), and 95% confidence intervals (CIs). ResultsDuring the follow-up, 6245 (17.4%) dementia onset cases were identified. The cumulative incidence of dementia was 16.2% in males and 18.4% in females. After adjusting for covariates, individual-level civic participation was associated with a lower incidence of dementia in both males and females (HR, 0.84; 95% CI, 0.77–0.92; HR, 0.78; 95% CI, 0.73–0.84). Community-level civic participation and social cohesion were associated with a lower incidence of dementia among females (HR, 0.96; 95% CI, 0.93–0.99; HR, 0.93; 95% CI, 0.88–0.98) and cross-level interaction on social cohesion among females (HR, 0.95; 95% CI, 0.90–0.99). ConclusionsLiving in a community with high civic participation and social cohesion is associated with a lower incidence of dementia among older females. Therefore, promoting civic participation and social cohesion in the community may be a useful population-based strategy to delay or prevent the onset of dementia.

Evaluation of preventive care for swallowing difficulty through policy changes in Japanese long-term care insurance: analysis of a nationwide claims dataset for long-term care insurance

BackgroundSwallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services.MethodsThe nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined.ResultsBetween 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users’ disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014.ConclusionsDue to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.

Sense of Coherence and Incident Dementia in Older Japanese Adults: The Japan Gerontological Evaluation Study

ObjectivesThe sense of coherence refers to effectively using available resources to manage stress and promote overall health. Previous studies have linked it to various health outcomes; however, evidence regarding its association with the risk of incident dementia is limited. Hence, this study aimed to fill this research gap using data from a large-scale population survey. DesignProspective cohort study. Setting and ParticipantsThis study included 31,556 participants aged 65 years and older who were free from dementia and disabilities. The participants were enrolled in the 2010 baseline survey of the Japan Gerontological Evaluation Study, and were followed up until the end of 2019. MethodsThe sense of coherence was assessed using a 6-item short-version questionnaire. Incident dementia cases were ascertained through the public long-term care insurance database in Japan. ResultsDuring a median follow-up of 8.3 years, 4326 incident dementia cases were identified. After adjusting for conventional risk factors, the hazard ratios (95% CIs) for each quintile compared to the lowest quintile of the sense of coherence were 0.82 (0.75-0.90), 0.75 (0.68-0.83), 0.76 (0.68-0.84), and 0.78 (0.70-0.87), respectively. The multivariable hazard ratio (95% CI) per 1-SD increment was 0.91 (0.88-0.95). These inverse associations did not exhibit any gender differences (P for gender interaction = .11) and were further confirmed after excluding early incident cases. Similar associations were found for its components; the corresponding multivariable hazard ratios (95% CIs) per 1-SD increment were 0.94 (0.91-0.97) for comprehensibility, 0.92 (0.89-0.95) for manageability, and 0.93 (0.90-0.97) for meaningfulness. Conclusions and ImplicationsModerate and above sense of coherence was associated with the lower risk of dementia among the older population, suggesting a beneficial role of stress management in maintaining the cognitive health of older adults.

Associations between older adults’ going-out frequency and land price of neighbourhoods: Potency of land price as an indicator of homebound tendency

The aim of this study is to identify the potency of land price as a general indicator of the homebound tendency of neighbourhoods. For this purpose, we focus on the associations between land price and older adults’ going-out frequency, while considering the similarities and differences from factors associated with walkability. The study targets are 19,270 individuals living in the Tokyo metropolitan area who are aged 65 years or older who are not certified as needing public long-term care insurance. This study uses a two-step procedure: a) the land price of each neighbourhood is estimated using rent price data from 2010 to 2019 collected by an official Japanese realtor organization; b) the associations between older adults’ goingout frequency, according to the 2016 Japan Gerontological Evaluation Study, and the estimated land price of their neighbourhoods is identified using multilevel analysis. The results indicate that land price has strong negative associations with older adults’ going-out frequency. Associations between land price or other walkability-associated factors, such as population density, ratio of commercial area, and proximity to the nearest train station, only appear when these factors and land price are included within the same model.The results suggest that, when inspecting homebound tendency in some neighbourhoods, factors relating to the built environment must be considered alongside land prices. Furthermore, the homebound status of older adults is a pressing challenge, especially in neighbourhoods with high land prices.

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.

Dynamic Effects of Long-Term Care Insurance on Healthcare Expenditures: Evidence from South Korea

Long-term care expenses pose a large financial risk to the elderly. In 2008, South Korea introduced a public long-term care insurance (LTCI) program for individuals older than 65. We study the dynamic effects of the LTCI on various healthcare expenditures. We find that after the implementation of the LTCI, average prescription drug and outpatient expenditures of the elderly increased. Dynamically, we observe that the growth in these expenditures moderates. We also find suggestive evidence that after the introduction of the LTCI, the elderly may utilize LTC hospitals instead of inpatient hospital services. These findings underscore the importance of understanding the long-term effects of LTCI on health and healthcare expenditures of the elderly and the need to account for interactions between LTC and other types of healthcare services in policy design.

Association between dairy intake and risk of incident dementia: the Ohsaki Cohort 2006 Study.

To investigate the association between dairy intake and risk of incident dementia in older adults. A longitudinal analysis of dairy intake with incident dementia was conducted using a cohort study of 11,637 non-disabled Japanese older adults aged ≥ 65years followed-up for up to 5.7years (mean: 5.0years). Data on milk, yogurt, and cheese intake were collected using a validated food frequency questionnaire. Total dairy intake was calculated as the sum of the daily intake of milk, yogurt, and cheese, which was sex-specifically categorized in quintiles. Dementia cases were retrieved from the public long-term care insurance database. Cox proportional hazards model was used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. During 58,013 person-years of follow-up, 946 persons developed dementia. In the primary analysis, compare to the lowest quintile of total dairy intake, Q2 showed a slightly decreased incident dementia risk (HR for Q2 vs Q1: 0.90, 95% CI: 0.73-1.10) after fully adjusted for demographic, lifestyle, psychological, and nutritional factors, and diseases history. Compared to non-consumers of milk, those consuming for 1-2 times/month showed a lower risk of incident dementia (fully-adjusted HR: 0.76, 95% CI: 0.57-1.02). Daily yogurt consumers also had a reduced risk (fully-adjusted HR: 0.89, 95% CI: 0.74-1.09). But daily cheese consumers showed an increased risk of dementia (fully-adjusted HR: 1.28, 95% CI: 0.91-1.79). In the sensitivity analysis where we excluded dementia cases ascertained in the first 2years, results were consistent with those from the primary analysis and we further found that yogurt intake might be inversely associated with dementia risk (p for trend = 0.025). Low total dairy intake or low milk intake frequency might be associated with lower incident dementia risk, however daily cheese consumers seemed to have an increased risk. Our study also suggested a possible inverse dose-response association between yogurt consumption and dementia risk, but further studies are needed to confirm whether this benefit was from yogurt intake itself or as a part of a healthy dietary pattern.

Controlling Spending For Health Care And Long-Term Care: Japan's Experience With A Rapidly Aging Society.

As the Japanese population has aged rapidly, Japan's experience has implications for other high-income countries, including the United States. The aging of Japan's population, coupled with the government's decision to implement a public long-term care insurance program in 2000, has increased the nation's expenditures. In acute care, costs have been relatively contained by biennially revising the fee schedule for all physician and hospital services and by lowering pharmaceutical prices. The fee schedule not only sets prices but also controls volume by setting the conditions of billing for each item. This fee schedule is applied to all social health insurance plans (which enroll all permanent residents of Japan) and to virtually all providers. In contrast, despite the use of a similar fee schedule, spending in long-term care insurance has increased more than spending in health care. This is both because long-term care became an entitlement and because aging has had a greater impact on long-term care insurance spending than on health insurance spending. In this article we analyze Japanese expenditure data to provide essential information to the US as the percentage of its population ages sixty-five and older continues to rise. A key lesson that the US can learn from Japan's experience is that as its population ages, the need for long-term care will increase, necessitating better control of acute care spending.

Psychological distress in later life and incident dementia: The Ohsaki Cohort 2006 Study

BackgroundThe role of reverse causation in the association between psychological distress and incident dementia remains unclear. We investigated whether psychological distress is a risk factor for, or prodromal symptom of, dementia. MethodsA longitudinal analysis of psychological distress with incident dementia was conducted among 12,076 Japanese individuals (age ≥65 years) followed for 5.7 years. Psychological distress was measured using the Kessler 6-item psychological distress scale (0–24 points) at baseline, with participants categorized into four psychological distress groups: no (0–4), mild (5–9), moderate (10–12), and serious (13–24). Dementia cases were retrieved from the public Long-term Care Insurance database. Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CIs) for incident dementia. Stratified analysis was conducted by cognitive function (higher or lower) at baseline. ResultsDuring 60,240 person-years of follow-up, 997 individuals developed dementia. A dose-response association was found between psychological distress and dementia; however, the stratified analysis indicated that this association depended on cognitive function at baseline. Among those with higher cognitive function at baseline, a significantly elevated dementia risk was observed only for serious psychological distress (HR: 2.04, 95%CI: 1.24–3.36). Among those with lower cognitive function, both moderate (HR: 1.30, 95%CI: 1.00–1.68) and serious (HR: 1.79, 95%CI: 1.37–2.34) psychological distress showed an increased dementia risk. ConclusionThe association between late-life psychological distress and incident dementia is partly explained by reserve causation, whereby mild and moderate distress could be a prodromal symptom of dementia.

Association of Dietary Variety with the Risk for Dementia: the Yabu Cohort Study.

The consumption of various foods is internationally recommended in healthy diet, although the association between dietary variety and incident dementia is unknown. We aimed to examine the association between dietary variety and the incidence of disabling dementia in older Japanese adults. We conducted a prospective cohort study. Dietary variety was assessed based on the Dietary Variety Score (DVS). DVS was assessed by counting the number of 10 food components (meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruit, seaweed, and fats/oils) that were consumed almost daily using a food frequency questionnaire. Participants were categorised into low (0-2 points), middle (3-4 points), and high (5-10 points) groups based on the DVS. Data on newly diagnosed disabling dementia were retrieved from the public long-term care insurance database. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Yabu cohort study, Japan. A total of 4972 community-dwelling adults aged 65 years or older. During the median follow-up of 6.8 years, 884 participants were newly diagnosed with disabling dementia. After adjusting for confounders, the multivariable-adjusted HR for incident disabling dementia was 0.82 (95% CI, 0.69-0.97) for participants in the highest DVS category compared to those in the lowest DVS category (P for trend=0.019). A higher dietary variety is associated with a reduced risk of disabling dementia in older Japanese adults. These results have potential implications for the development of effective public nutritional approaches to prevent dementia in older adults.

Association of frailty with influenza and hospitalization due to influenza among independent older adults: a longitudinal study of Japan Gerontological Evaluation Study (JAGES)

BackgroundIt is unknown that whether frailty is a risk factor of influenza and the hospitalization among older adults, although it has been shown that frailty was associated with poor recovery from the hospitalization among those. We examined the association of frailty with influenza and the hospitalization and the effect by sex among independent older adults.MethodsWe used the longitudinal data from the Japan Gerontological Evaluation Study (JAGES), performed in 2016 and 2019 and conducted in 28 municipalities in Japan. The target population comprised 77,103 persons aged ≥ 65 years who did not need assistance from the public long-term care insurance. Primary outcome measures were influenza and hospitalization due to influenza. Frailty was evaluated with the Kihon check list. We estimated the risk of influenza, the hospitalization, those risks by sex, and the interaction for frailty and sex using Poisson regression adjusting for covariates.ResultsFrailty was associated with both influenza and the hospitalization among the older adults compared with nonfrail individuals after adjusting for covariates (influenza, frail: risk ratio {RR}: 1.36, 95% confidence interval {95% CI}: 1.20 − 1.53, and prefrail: RR: 1.16, 95% CI: 1.09 − 1.23; the hospitalization, frail: RR: 3.18, 95% CI: 1.84 − 5.57, and prefrail: RR: 2.13, 95% CI: 1.44 − 3.16). Male was associated with the hospitalization, but not associated with influenza compared to female (the hospitalization: RR: 1.70, 95% CI: 1.15 − 2.52 and influenza: RR: 1.01, 95% CI: 0.95 − 1.08). The interaction for frailty and sex was significant neither in influenza nor in the hospitalization.ConclusionThese results suggest that frailty is a risk of influenza and the hospitalization, that risks of the hospitalization are different by sex, but that the sex difference does not cause the effect heterogeneity of frailty on the susceptibility and severity among independent older adults.

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.