Analysis of Causes of Dependency Under the Long Term Care Insurance Scheme in Japan

Hayashida

Kubo

et al. 2010

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In order to investigate the appropriateness of the health promotion program targeting to the slightly frail aged, the authors analyzed the data of 5,193 aged who received the screening test for dependency in 2008. After calculating the descriptive statistics for basic characteristics, such as age, sex, and results of screening test, the factor associated with degradation of dependency level were analyzed by a logistic regression model. If a person becomes a user of LTCI covered services, this person is evaluated as "become dependent". Higher age category, male, bad mobility score, higher tendency to stay indoors (Tojikomori) and bad dementia score were detected as statistically significant risk factors in the current study. It is interesting that use of preventive services was detected as a risk factor of degradation of dependency level. Mismatch of expectation of users and organized services, supply side induced demand and mismatch between LTCI eligibility assessment and 25-items screening test were considered as possible reasons. In order to ameliorate the effectiveness of program, it is necessary to reconsider the content of screening test and preventive services.

Section: Methodssupporting

confidence: 62%

Factors Associated with the Degradation of Dependency Level among the Slightly Frail Aged in a Japanese Community

Hayashida

Kubo

et al. 2010

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“…For LTCI, the special program for maintenance and amelioration of ADL status has been introduced 5,6) . The slightly frail aged has to receive the preventive ADL services.…”

Section: ❖ Introductionmentioning

confidence: 99%

Analysis of the Relationship between Depression and Changes in ADL Status among the Japanese Aged

Fujino

2008

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In 2006 the Ministry of Health, Labor and Welfare (MHLW) has launched the 2006 Health care reform plan. One of the characteristics of this plan is to value the preventive activities. Most of these programs mainly focus to the disease specific symptoms and outcomes such as pain, weakness of muscle, and little attention is paid to the mental depression. In order to evaluate the effect of depressive situation on changes in Activity of Daily Living (ADL) level, we have organized and analyzed a two year's panel data (2004)(2005)) that contains about 1800 aged living in a city of western Japan. For evaluation of ADL level and depression status, Typology of Aged with Illustration (TAI) and Geriatric Depression Scale five item version (GDS5) were used, respectively. After evaluating the results of descriptive analyses, logistic regression analyses were conducted in order to analyze the factors associated with aggravation of ADL levels between 2004 and 2005. The results indicated that depressive status has significant influence on changes in ADL independency status, that is, the person with higher depression situation showed the higher possibility of worsening the ADL level. higher depression situation were related to the worsening of mobility (OR=0.749, 95%CI=0.655-0.857), mental status (OR=0.606, 95%CI=0.489-0.750), eating (OR=0.603, 95%CI=0.458-0.793), toileting (OR=0.564, 95%CI=0.456-0.698), and bathing (OR=0.647, 95%CI=0.551-0.760). The results of our study have suggested that the health promotion activities for the aged must pay enough attention for the depression problem in order to improve and to maintain their ADL independency.

“…As our previous study indicated [5][6][7] , higher age category, male, bad mobility score, higher tendency to stay indoors (Tojikomori) and bad dementia score were detected as statistically significant risk factors of degradation of dependency level among the frail elderly. The official 25-items for case findings of frail elderly that is currently used, does not include age or health status.…”

Section: Discussionmentioning

confidence: 81%

Development of Short Screening Questionnaire for the Frail Elderly

Hayashida

2011

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As Japan tries to balance the volume of long term care for the aged and its financing by promoting the preventive activities for slightly frail elderly, a simple case finding instrument is needed in order to implement really effective programs. For this purpose, the MHLW has introduced a 25 items questionnaire for case finding. However, this instrument is considered inappropriate because of its low sensitivity. In order to improve the situation, we have developed an 8 items' simple questionnaire, so called Quick 8. According to the ROC analysis based on the data of 289 aged who received the secondary in-depth assessment, It seems the criteria "more than equal 4 (sensitivity=1.00 and specificity =0.714)" is appropriate as threshold. The effectiveness and validity of this new instrument must be examined by larger scale of field studies in future.