Public Long-term Care Insurance Research Articles

Estimating nutrition intake status of community-dwelling elderly people requiring care in disaster settings: A preliminary cross-sectional survey.

There are a lack of disaster preparedness measures that target populations with dysphagia. In particular, disaster response plans frequently overlook differences in textures between emergency foods and regularly consumed foods. The aim of this study was to estimate the number of community-dwelling elderly care recipients requiring specific food preparations, including the population at risk of aspiration when solely consuming common emergency foods. A cross-sectional study. Community-dwelling elderly care recipients who were certified by the public long-term care insurance system in Japan and registered at one of 77 care managing offices in Shinjuku city. Special needs regarding food intake and risks associated with receiving emergency foods were assessed by government-certified care managers. Data were acquired from 1,271 care recipients. Notably, 23.1% of the sampled population had special needs regarding food intake at all times (e.g. non-oral intake or need for texture-modified foods). An additional 11.5% were estimated to experience difficulty when ingesting common emergency foods, despite the ability to consume regular foods. A relatively large portion of community-dwelling elderly people will be at risk of aspiration due to the intake of commonly distributed emergency foods following a disaster. Appropriate preparation based on an assessment of special needs regarding food intake is therefore required when planning for future disasters.

Dietary Inflammatory Index and Disability-Free Survival in Community-Dwelling Older Adults.

Background: Previous studies have reported that a higher dietary inflammatory index (DII®) score is related to a higher risk of mortality and conditions that result in functional disability, such as cardiovascular disease, dementia, and fractures. Although these findings suggest that higher DII scores would affect disability-free survival, this has never been investigated directly. The present study investigated the association between the DII score and disability-free survival. Methods: We analyzed follow-up data covering a 12-year period for 793 older adults (≥70 years) participating in a Japanese community-based cohort study. DII scores were computed on the basis of dietary intake and assessed using the Brief Self-Administered Diet History Questionnaire. Data on incident functional disability were retrieved from the public Long-Term Care Insurance database. We applied the Cox model for estimating the adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death) according to DII score tertiles (T1–T3). Results: The proportion of men was 47.3%; mean (SD) age was 75.2 (4.5) years. The 12-year incidence of the composite outcome was 65.5%. A higher DII score was related to a higher risk for the composite outcome: HRs (95% confidence interval) were 1.05 (0.84, 1.32) for T2 and 1.26 (1.01, 1.57) for T3 (p-trend = 0.040) compared to the most anti-inflammatory T1 reference (HR = 1.00). Conclusions: These results suggest that a pro-inflammatory diet might be a modifiable factor affecting disability-free survival in the older population. Additional prospective studies are needed to confirm this relationship.

In-hospital dementia-related deaths following implementation of the national dementia plan: observational study of national death certificates from 1996 to 2016

ObjectiveTo examine changes in places of dementia-related death following implementation of the national dementia plan and other policy initiatives.DesignObservational study.SettingJapan between October 1996 and September 2016. Four major changes in...

일본의 개호보험제도와 장애인복지제도의 제도 간 조정에 관한 고찰 : 개호보험우선원칙을 둘러싼 문제 상황과 한국에의 시사

본 연구는 일본의 개호보험제도와 장애인복지제도의 제도 간 조정에 관한 고찰을 통해 한국에의 시사점을 얻고자 한 것이다. 연구의 목적을 달성하기 위해 먼저, 두 제도 간 조정관계에 있어서 중요한 변수로 작용한 개호보험우선원칙의 내용과 전개과정을 살펴보았다. 그리고 이 과정에서 나타난 주요 쟁점인 서비스의 선택 및 병용 문제와 이용자부담 문제를 중심으로, 후생노동성이 실시한 각 지자체의 운용실태조사와 이에 관련된 대표적인 사례인 ‘아사다 소송’의 분석을 통해 개호보험 우선원칙을 둘러싼 문제의 실태를 살펴보았다. 또한 일본의 개호보험제도와 장애인복지제도의 제도 간 조정에 있어서 발생하고 있는 문제의 근본적인 원인과 정책적 과제를 검토하였으며, 이를 통해 향후 우리나라 노인장기요양보험제도와 장애인복지제도의 제도 간 조정에 관한 시사점을 얻고자 하였다.BR 연구 결과, 일본에서는 개호보험제도와 장애인복지제도의 제도 간 조정에 있어서 개호보험우선원칙에 관련된 다소 모호한 법률상의 규정에 따라 법률의 해석이 다르게 나타날 수 있음이 실태조사를 통해 확인되었다. 또한 아사다 소송의 분석을 통해 개호보험우선원칙의 적용으로 인한 서비스 양의 감소, 이용료부담의 증가, 환경변화에의 부적응 등에 따른 다양한 문제 상황과 개호보험우선원칙이 가진 모순과 폐해를 확인할 수 있었다.BR 이와 같은 일본의 개호보험제도와 장애인복지제도의 제도 간 조정에 관한 고찰을 통해 한국에서도 장애노인의 개별적 욕구에 맞는 서비스를 선택 및 병용할 수 있는 제도 간 조정이 이루어져야 한다는 점, 서비스 전환에 따른 이용자부담 문제에 대한 재검토가 이루어져야 한다는 점, 제도 간 조정관계에 관한 이론적 검토가 필요하다는 점 등의 시사점을 얻을 수 있었다.

Impact of time spent walking on incident dementia in elderly Japanese.

This study examined the hypothesis that time spent walking daily has a marked impact on incident dementia. First, we analyzed data from a Japanese cohort (n=13990 aged ≥65y) to obtain hazard ratios. Time spent walking per day (<0.5, 0.5-1, or ≥1h) was assessed using a self-reported questionnaire. Data on 5.7-year incident dementia were retrieved from the public long-term care insurance database. After estimating the multivariate-adjusted hazard ratios (HRs) of incident dementia using the Cox model, the population attributable fraction (PAF) was calculated using the prevalence in a representative Japanese survey, the "National Health and Nutrition Survey". The time spent walking per day showed an inverse association with incident dementia: the multiple-adjusted HRs (95% confidence intervals) were 1.00 (reference) for less than 0.5hour, 0.81 [0.71, 0.92] for 0.5 to 1hour, and 0.72 [0.62, 0.84] for more than or equal to 1hour. Our estimates indicate that 18.1% of dementia cases would be attributable to walking if all subjects walked more than or equal to 1h/d and 14.0% if subjects increased their daily time spent walking to one level above the present one (<0.5 to 0.5-1 or 0.5-1 to ≥1h). Our results suggest that the daily time spent walking has a considerable preventive impact on incident dementia in Japan.

The Impact of Psychological Distress on Incident Functional Disability in Elderly Japanese: The Ohsaki Cohort 2006 Study.

Background: Although psychological distress is known to be a risk factor for death, there are relatively few data on the impact of psychological distress on incident functional disability in older adults. The aim of this study was to examine the impact of psychological distress on incident functional disability in older adults. Methods: We conducted a cohort study of 12,365 disability-free individuals aged ≥65 years who live in Ohsaki City, Japan. In 2006, the level of psychological distress was assessed using the K6 (range: 0–24 points). Data on 10-year functional disability were retrieved from the public Long-term Care Insurance database. The multivariate-adjusted hazard ratios (HRs) and population attributable fractions (PAFs) according to the K6 groups (<5, 5–9, 10–12, and ≥13 points) were estimated. Results: Among 94,636 person-years, incident functional disability occurred in 4533 persons (36.7%). Significantly higher risk was observed in higher K6 score groups. The multiple-adjusted HRs (95% CIs) of incident functional disability were 1.14 (1.06–1.22) for 5–9 points, 1.28 (1.15–1.43) for 10–12 points, and 1.62 (1.44–1.84) for ≥13 points, in comparison with <5 points (p-trend < 0.001). The PAFs in each of the K6 score groups were 3.0% for 5–9 points, 1.7% for 10–12 points, and 2.6% for ≥13 points. Conclusions: Even when mild to moderate, psychological distress had a considerable impact on incident functional disability in this cohort.

The 2015 long-term care reform in the Netherlands: Getting the financial incentives right?

In 2015 the system of long-term care (LTC) financing and provision in the Netherlands was profoundly reformed. The benefits covered by the former comprehensive public LTC insurance scheme were split up and allocated to three different financing regimes. The objectives of the reform were to improve the coordination between LTC, medical care and social care, and to reinforce incentives for an efficient provision of care by making risk-bearing health insurers and municipalities responsible for procurement. Unintentionally, the reform also created a number of major incentive problems, however, resulting from the way: (i) LTC benefits were split up across the three financing regimes; (ii) the various third party purchasers were compensated; and (iii) co-payments for the beneficiaries were designed. These incentive problems may result in cost shifting, lack of coordination between various LTC providers, inefficient use of LTC services and quality skimping. We discuss several options to get the financial incentives better aligned with the objectives of the reform.

Changes in sleep duration and the risk of incident dementia in the elderly Japanese: the Ohsaki Cohort 2006 Study.

Study ObjectivesTo examine the association between changes in sleep duration and the risk of incident dementia in the elderly.MethodsIn 2006, we conducted a cohort study of 7422 disability-free Japanese individuals aged ≥65 years who lived in Ohsaki City, Japan. In both 1994 and 2006, the individual amount of sleep obtained was assessed using a self-reported questionnaire. Based on sleep duration at these two time points, participants were categorized into five groups according to the change in sleep duration. Data on incident dementia were retrieved from the public Long-term Care Insurance database, and the subjects were followed up for 5.7 years (between April 2007 and November 2012). The Cox proportional hazards model was used to estimate the multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia.ResultsDuring 36338 person-years of follow up, 688 cases of incident dementia were documented. Compared with subjects who had no change in sleep duration, the multivariate HRs (95% CIs) of incident dementia were 1.31 (1.07 to 1.60) for those whose sleep duration increased by 1 hr, and 2.01 (1.51 to 2.69) for an increase of ≥2 hr.ConclusionsIncreased sleep duration is associated with a significantly higher risk of incident dementia in the elderly. Future studies using well-validated measurements are needed to confirm the association between sleep and dementia.

Association between social participation and incident risk of functional disability in elderly Japanese: The Ohsaki Cohort 2006

BackgroundAlthough several longitudinal studies have examined the relationship between social participation and incident functional disability, the related mechanisms have remained unclear. The aim of this study was to examine the mechanisms linking social participation to incident functional disability. MethodsWe analyzed follow-up data for 11,992 older adults (≥65 years) participating in a community-based, prospective cohort study covering a 9-year period. At the baseline, the subjects were asked about three types of participation in community activities (volunteering, hobbies, and neighborhood associations) and the frequency of their participation. Data on incident functional disability were retrieved from the public Long-term Care Insurance database. The Cox model was used to estimate the multivariate-adjusted hazard ratios of incident functional disability. We then conducted mediation analysis to assess the magnitude of the mediating effect. ResultsAmong 84,760 person-years of follow-up, there were 3,984 cases of incident functional disability. The hazard ratio was 0.79 (95% CI: 0.73-0.86) for participating in one type of activity, 0.82 (95% CI: 0.74-0.90) for two types of activity and 0.70 (95% CI: 0.64-0.77) for three types of activity in comparison with no participation in any activity. Among the estimated mediating effects, cognitive activity accounted for 9.3%, time spent walking for 8.3%, psychological state for 4.6%, and social support for 2.8% of the reduced risk of incident functional disability. ConclusionThe results of this population-based cohort study indicate that cognitive activity and time spent walking are important mechanisms linking social participation to incident functional disability.

Corrigendum: Changes in time spent walking and the risk of incident dementia in older Japanese people: the Ohsaki Cohort 2006 Study.

Background the impact of long-term changes in physical activity during adulthood in the context of primary prevention of dementia has not been addressed previously. Objective to study the relationship between changes in time spent walking after middle age and incident dementia in older Japanese individuals. Methodology we conducted a cohort study of 6,909 disability-free Japanese individuals aged ≥65 years who lived in Ohsaki City, Japan. In both 1994 and 2006, the individual amount of time spent walking per day was assessed using a self-reported questionnaire (<0.5 h, 0.5-1 h or ≥1 h). Based on these three categories of exposure at the two points, participants were categorised into nine groups according to changes in time spent walking. Data on incident dementia were retrieved from the public Long-term Care Insurance (LTCI) Database, in which participants were followed up for 5.7 years (between April 2007 and November 2012). The Cox model was used for estimating the multivariate-adjusted hazard ratios (HRs) of incident dementia. Results the 5.7-year incidence of dementia was 9.2%. Compared with persons who remained in the lowest category of time spent walking (<0.5 h/day in both 1994 and 2006), persons who remained in the highest category (≥1 h/day in both 1994 and 2006) had a significantly lower risk of incident dementia: the multivariate-adjusted HR (95% confidence intervals) was 0.72 (0.53 and 0.97). Conclusions these results suggest that maintaining a higher level of physical activity after middle age may be a key strategy for prevention of dementia in older age.

Income-based inequalities in caregiving time and depressive symptoms among older family caregivers under the Japanese long-term care insurance system: A cross-sectional analysis.

AimLong-term care systems may alleviate caregiver burdens, particularly for those with fewer resources. However, it remains unclear whether socioeconomic disparity in caregiver burdens exists under a public, universal long-term care insurance (LTCI) system. This study examined income-based inequalities in caregiving time and depressive symptoms in Japanese older family caregivers. We further compared inequality in depressive symptoms with that of non-caregivers to evaluate whether family caregiving exacerbates this disparity.MethodsData were obtained from a cross-sectional, nationwide survey conducted by the Japan Gerontological Evaluation Study in 2013. Participants were functionally independent older adults aged ≥65 years (N = 21,584). Depressive symptoms were assessed using the Geriatrics Depression Scale (GDS); caregiving hours per week, household income, and other covariates were also assessed.ResultsFamily caregivers occupied 8.3% of the total. A Poisson regression model revealed that caregivers in lower income groups (compared to those in the highest) were 1.32 to 1.95 and 1.63 to 2.68 times more likely to engage in ≥36 and ≥72 hours/week of caregiving, respectively. As for the GDS (≥5), an excess risk was found in the caregivers in lower (compared to higher) income groups (adjusted prevalence ratio: 1.57–3.10). However, an interaction effect of income by caregiving role indicated no significant difference in inequality between caregivers and non-caregivers (p = .603). The excess risk for GDS (≥5) in the caregivers compared to non-caregivers was observed across income groups.ConclusionsOur findings revealed a possible disparity in family caregivers under the public LTCI system. Further studies should examine factors associated with longer caregiving hours in lower income households. Our findings also suggest the necessity for more efforts to alleviate depressive symptoms in family caregivers under the LTCI system regardless of income level, rather than exclusively supporting those with a low income.

The future prospect of the long-term care insurance in Japan

This paper explores the impact of population aging on the Japanese public long-term care insurance (LTCI) within a numerical dynamic general equilibrium model with multiple overlapping generations. The impact of three policy options, such as an increase in co-payments, an earlier starting age of contribution, and more distribution of the cost to the public sector, is also examined. The numerical results show that in the next about forty years the burdens on the first (age 65 and over) and second (age 40 to 64) groups become more than 1.7 times and more than 2.7 times as much, respectively. A relatively more increase in the burdens on the second group cannot be avoidable, even if adjustment of the cost distribution between both groups is made every three years in the future in accordance with the schedule by the MHLW. Furthermore, in order to reduce future burdens in the LTCI, an increase in co-payments is most preferable, rather than an earlier starting age of contribution in the longer duration with lower annual burdens, or a shift of the cost to the public sector with a very high consumption tax.

Uncertain Altruism and Non-Linear Long-Term Care Policies

We study the design of public long-term care (LTC) insurance when the altruism of informal caregivers is uncertain. We consider non-linear policies where the LTC benefit depends on the level of informal care, which is assumed to be observable while children’s altruism is not. The traditional topping up and opting out policies are special cases of ours. Both total and informal care should increase with the children’s level of altruism. This obtains under full and asymmetric information. Social LTC, on the other hand, may be non-monotonic. Under asymmetric information, social LTC is lower than its full information level for the lowest level of altruism, while it is distorted upward for the higher level of altruism. This is explained by the need to provide incentives to high-altruism children. The implementing contract is always such that social care increases with formal care.

Uncertain Altruism and Non-Linear Long-Term Care Policies

We study the design of public long-term care (LTC) insurance when the altruism of informal caregivers is uncertain. We consider non-linear policies where the LTC benefit depends on the level of informal care, which is assumed to be observable while children's altruism is not. The traditional topping up and opting out policies are special cases of ours. Both total and informal care should increase with the children's level of altruism. This obtains under full and asymmetric information. Social LTC, on the other hand, may be non-monotonic. Under asymmetric information, social LTC is lower than its full information level for the lowest level of altruism, while it is distorted upward for the higher level of altruism. This is explained by the need to provide incentives to high-altruism children. The implementing contract is always such that social care increases with formal care.

Healthcare Needs of the Elderly People over 85 Years Living Alone on the Island Area in Japan: A Descriptive Study

Background: Japan has the highest aging people accounting 33.8 million with the rate of 26.7% in 2015. Although, public long-term care insurance services support people age 40 years and above, most of the users are 85 years and over due to their more vulnerability for getting sick. This study describes the physical, mental and social status of the elderly people aged 85 years and over, who were living alone at home. Method: A cross-sectional study was conducted between November 2016 and March 2017 in the island of Kure city, Hiroshima, Japan. A structured questionnaire and scales were used for data collection and documentation of physical measurements. Descriptive analysis was used. Result: A total of 190 subjects were participated, and the data were analyzed. The age range of the subjects was 85 to 98 years, and 68.4% of them were 85 to 89 years old. Male and female ratio was 21.6% vs 78.4%. Subjects of 17.4% continued their occupation at the time of the study period and most of them involved in agricultural work (93.9%). A certain percentage of the subjects had abnormal physical, mental and social difficulties and need additional support from family, friends, relatives, and community. Conclusion: Early detection and intervention such as disease management, nutritional support, and human support are required. The findings suggested policy makers to predict the burden and provide necessary care for these elderly people. It is necessary to aware family, friends, relatives, community and government supporting staff to provide information on correct recognition and usages of long-term care insurance services for these elder people.

Use of In-Home Services of the Public Long-Term Care Insurance System by Elderly Foreign Residents in Osaka City: Care Managers’ Perception

Use of In-Home Services of the Public Long-Term Care Insurance System by Elderly Foreign Residents in Osaka City: Care Managers’ Perception

Spillover effect of Japanese long-term care insurance as an employment promotion policy for family caregivers

We evaluate a spillover effect of the Japanese public long-term care insurance (LTCI) as a policy to stimulate family caregivers’ labor force participation. Using nationally representative data from 1995 to 2013, we apply difference-in-difference propensity score matching to investigate the spillover effect in two periods: before and after the introduction of the LTCI in 2000 and before and after its major amendment in 2006. Our results show that the LTCI introduction has significant and positive spillover effects on family caregivers’ labor force participation and the effects vary by gender and age. In contrast, the LTCI amendment is found to have generally negative spillover effects on their labor force participation. We draw attention to these spillover effects, as expanding labor market supply to sustain the economy would be a priority for Japan and other rapidly aging countries in the coming decades.

Association of care recipients' care-need level with family caregiver participation in health check-ups in Japan.

The public mandatory long-term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check-ups in Japan. The present study was a cross-sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients' care-need level and in-home caregiver participation in health check-ups during the last year of the survey for caregivers. A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check-up by care-need level were 68.4% (support required 1 and 2), 63.5% (care required 1-3) and 60.3% (care required 4 and 5). Higher care-need level was negatively associated with caregiver participation in health check-ups (support required 1 and 2as reference, care required 1-3: odds ratio 0.82, 95% confidence interval 0.75-0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74-0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self-rating of health as independent variables did not change the result. These results suggest that facilitating health check-up participation for family caregivers of care recipients with higher care-need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2018; 18: 26-32.

Psychological distress and the incident risk of functional disability in elderly survivors after the Great East Japan Earthquake

BackgroundWe conducted a prospective cohort study to investigate whether psychological distress would have increased the incident risk of functional disability after the 2011 Great East Japan Earthquake. MethodsFirst phase data pertaining to psychological distress and other lifestyle factors were collected from 1037 subjects aged ≥ 65 years, from June to December 2011, in four affected areas of Miyagi prefecture in Japan. Psychological distress was measured by the Kessler 6-item psychological distress scale (K6), and classified into three categories (K6 score ≤ 9, 10–12, ≥ 13). Outcome data on functional disability were collected from the public Long-term Care Insurance database. Participants were followed up for about 2.6 years. The Cox model was used to calculate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs). ResultsDuring the follow-up period, 118 participants were certified as incident disability (43.8 disability events per 1000 person-years). Compared with the lowest category (K6 score ≤ 9), participants in the highest category (K6 score ≥ 13) had a significantly higher risk of functional disability (HR = 2.65, 95% CI = 1.35-5.18, p = 0.002). In order to consider reverse causality, we conducted analysis excluding all incidents and deaths that occurred within the first year of follow-up, but our findings remained unchanged. LimitationsWe did not consider all potential confounders and use of appropriate medication. ConclusionsThe present study has demonstrated that psychological distress was associated with an increased risk of functional disability among elderly survivors of a natural disaster.

The Relationship between Public Long-Term Care Insurance Awareness and Preparation for Later Life in South Korea

ABSTRACTAn increased focus on individual preparation for later life paired with a shift in family support within South Korea makes it necessary to study factors that influence preparation for later life among South Korean adults. This study examined whether the awareness of public long-term care insurance (LTCI) was related to South Koreans' financial, psychosocial, and physical preparations for later life. Data from the third wave (2009) and third supplement wave (2010) of the Korean Retirement and Income Study (KReIS) yielded a sample of 2,487 middle-aged adults. Multiple regression analyses were used to compare the influence of the awareness of public LTCI on financial, psychosocial, and physical preparation by dividing the sample into negative status and positive status groups based on subjective perceptions of current economic, relationship, and health conditions. The results showed that being aware of public LTCI increased preparation for later life in financial, psychosocial, and physical domains. In addition, participants in the negative status group had higher scores for psychosocial and physical preparation than individuals who perceived themselves as being in relatively better situations. These findings suggest that the policy makers and practitioners should include education on LTCI and the risks it targets across various preparation domains as well as account for differences in perception and preparation among sub-populations of middle-aged adults in order to ensure effective social policies for the elderly population.