Background: Alzheimer’s disease (AD) increases societal costs and decreases the activities of daily living (ADL) and quality of life (QoL) of the affected individuals. Objective: We assess the impact of AD severity on ADL, QoL, and caregiving costs in Japanese facilities for the elderly. Methods: Patients with AD in facilities for the elderly were included (47 facilities, N = 3,461). The QoL, ADL, and disease severity of patients were assessed using Barthel Index (BI), EuroQoL-5D-5L (EQ-5D-5L), and Mini-Mental State Examination (MMSE), respectively. Annual caregiving costs were estimated using patients’ claims data. The patients were subcategorized into the following three groups according to the MMSE score: mild (21≤MMSE≤30), moderate (11≤MMSE≤20), and severe (0≤MMSE≤10). Changes among the three groups were evaluated using the Jonckheere-Terpstra test. Results: Four hundred and one participants were on anti-AD medicines, of whom 287 (age: 86.1±6.4 years, 76.7% women) in the mild (n = 53, 84.0±6.9 years, 71.7%), moderate (n = 118, 86.6±5.9 years, 76.3%), and severe (n = 116, 86.6±6.5 years, 79.3%) groups completed the study questionnaires. The mean BI and EQ-5D-5L scores for each group were 83.6, 65.1, and 32.8 and 0.801, 0.662, and 0.436, respectively. The mean annual caregiving costs were 2.111, 2.470, and 2.809 million JPY, respectively. As AD worsened, the BI and EQ-5D-5L scores decreased and annual caregiving costs increased significantly. Conclusion: AD severity has an impact on QoL, ADL, and caregiving costs.

Background Improvements in the use of polypharmacy or potentially inappropriate medication (PIM) may reduce medication costs in Japan. We aimed to evaluate the impact of improvement in prescription on both overall health outcomes and medication costs in Japanese facilities for older people. Methods Residents in Japanese facilities for older people between March 2019 and March 2020 were included in this study. The following five indices were used to evaluate overall health outcomes: EuroQoL-5D-5L, Barthel Index, Mini Mental State Examination, Dementia Behaviour Disturbance Scale, and Vitality Index. The team, which consisted of one physician and several pharmacists, suggested improved prescriptions for the attending physicians of the participants. The impact of improvement in prescriptions on the health outcomes score, medication costs, and the number of medications were evaluated through two comparison groups: those whose number of medications decreased (decrement group, DG) and those whose medications did not (not decrement group, NDG); those prescribed PIMs in March 2019 and those not prescribed PIMs in March 2020 (improvement group, IG) and those prescribed PIMs both in March 2019 and March 2020 (not improvement group, NIG). In both comparison groups, propensity score matching was performed to balance demographics, and all health outcome scores, medication costs, and the number of medications in March 2020 were assessed using a t-test. Statistical significance was set at a p-value of < 0.05. Results Eight-hundred-and-ninety-one participants (75.5% women, 86.2 ± 7.9 years old) were enrolled. After matching, in the comparison between the DG (N = 232, 77.2%, 85.7 ± 8.5) and NDG (N = 232, 78.5%, 86.0 ± 3.1), changes in the health outcomes score were nonsignificant. However, the medication costs and the number of medications significantly decreased. After matching, in the comparison between IG (N = 141, 75.2%, 86.7 ± 8.1) and NIG (N = 273, 74.2%, 86.2 ± 8.3), changes in health outcome scores and medication costs were not significant. However, the number of medications significantly decreased. Conclusions Improvements in prescriptions did not adversely affect the overall health outcomes. However, it impacted medication costs and the number of medications. Improvement in prescriptions could decrease medication costs while maintaining overall health outcomes.

Background Japan has the highest proportion of elderly aged 65 and over in the world, which accounts for 28.1% in 2018, and expected to reach 30.0% in 2025 and over 20% of those will suffer from dementia. This study aimed to evaluate the impact of severity of dementia on quality of life (QoL), activity of daily living (ADL), medical costs and caregiving costs in Japan. Method People living in nursing home under the Life Company Limited (N=2,114) were enrolled. Their QoL, ADL, and the severity of dementia were assessed by staff working in the facilities by using Euro‐QoL 5 dimension (EQ‐5D), Barthel Index (BI) and Mini‐Mental State Examination (MMSE), respectively. The medical and caregiving costs were derived from payment records and claim data between December 2018 and September 2019, respectively. All participants were sub‐categorized by MMSE score into three dementia groups of mild (21≦MMSE≦30), moderate (11≦MMSE≦20), and severe (0≦MMSE≦10). All results were assessed by using Shirley‐Williams test. Result Survey was conducted on Mar. 2019 and 1,491 people completed the entire questionnaires, of which, 592 used medical cares and 1,424 records for caregiving activities. Using MMSE scores, 561 were classified to mild group with mean age (SD) 84.9±8.7 years old and 67.7% accounted for women, 491 to moderate (87.3±6.9y, 73.9%) and 439 to severe (87.4±7.7y, 73.1%). Mean EQ‐5D scores for three groups were 0.75, 0.63 and 0.40, respectively. Mean BI scores were 78.5, 62.4, and 24.9, respectively. Significant decrements for both EQ‐5D and BI scores were observed for severe against mild or moderate groups. Annual out‐of‐pocket medical costs were not statistically differed by severity, or JPY11,445, 12,548 and 10,764 for mild, moderate and severe patients, respectively(not significant), while annual caregiving costs were increased as dementia becomes severer, or JPY2.1Mil, 2.4Mil and 2.8Mil for mild, moderate and severe patients, respectively (p<0.05) Conclusion Severity of dementia significantly impairs QoL and ADL, as observed from score decrements in EQ‐5D, BI and caregiving costs when severity worsened, while no significant difference was observed for medical costs.