Characteristics of patients discontinuing outpatient services under long-term care insurance and its effect on frailty during COVID-19

Abstract

Background Among community-dwelling older adults who require long-term care and use outpatient rehabilitation services, we aimed to examine the characteristics of patients who discontinued using outpatient rehabilitation services to prevent exposure to COVID-19 and the effects of this discontinuation on patient frailty. Methods Participants were 119 older adults (69 males, 50 females; average age 77.3 ± 8.3 years) requiring long-term care who used outpatient rehabilitation services. Our outpatient rehabilitation service involved day care for older adults undergoing rehabilitation including pick-up and drop-off services under the long-term care insurance system. They were divided into two groups: participants who discontinued using outpatient rehabilitation services and participants who continued their use. To find the factors associated with this discontinuation, binomial logistic regression analysis was performed, in which the following independent variables were used: gender, age, height, weight, long-term care level, grip strength, and normal walking speed. Frailty status was investigated in April 2020 and again in September 2020 through interviews and telephone surveys utilizing the Frailty Screening Index. Results Women and normal walking speed were independent factors associated with the discontinuation of outpatient rehabilitation due to COVID-19. According to the results of the Frailty Screening Index, similar tendencies were exhibited in both April and September. The discontinued group indicated that they were getting less exercise and having stronger feelings of fatigue than the continuing group. Conclusions The findings are in accordance with other studies indicating that women are more likely to employ prevention measures against COVID-19, as seen among the community-dwelling older adults requiring long-term care who used outpatient rehabilitation services. People with higher levels of physical function were also likely to refrain from using outpatient rehabilitation services. Results further suggested that the discontinued group had more frailty-related factors (i.e., low physical activity and strong exhaustion) than the continuing group.

Kihon Checklist items associated with the development of frailty and recovery to robust status during the COVID‐19 pandemic

“…A lack of community activities and interactions may have negative physical, psychological, spiritual and social effects on older adults. [1][2][3][4][5][6][7][8] The Cardiovascular Health Study criteria and frailty index are widely used as evaluation indexes of frailty. However, the Kihon Checklist (KCL) is considered a representative assessment tool for frailty and is recommended in clinical guidelines.…”

“…A lack of community activities and interactions may have negative physical, psychological, spiritual and social effects on older adults. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 …”

Change in long‐term care service usage in Japan following the COVID‐19 pandemic: A survey using a nationwide statistical summary in 2018–2021

“…Some LTC users stopped using LTC services because of excessive concerns or anxieties over infection, and some had a reduced need to | 807 continue with LTC services because they had been relatively independent previously. 29 These are acceptable as reasons that led to the decreased use of outpatient or short-stay services. Although the reason for the decline in usage should thus include factors attributable to the demand side and supply side of services, it would be difficult to distinguish between these factors using a database approach, even if we had used a comprehensive nationwide claims database.…”

Change in the trend of long-term care service usage following COVID-19 pandemic in Japan: a survey using nationwide statistical summary in 2018-2021

“…We can enumerate various kinds of scenarios in which individual community-dwelling LTC users did not receive LTC services as before the pandemic, such as follows: LTC facilities providing services were temporarily closed due to nosocomial outbreak (or 'cluster') [Iritani 2020], LTC users were required to self-isolate in their homes because they were considered as a close contact since their family member living together became COVID-19 positive, LTC users' excessive concerns or anxieties of infection prevented them from using LTC services, or some LTC users had a lower need to continue LTC services because they had relatively been independent since previously [Hirose 2021]. What we need to note is that the reason for the decline in use is not only due to factors on the demand side of the service, but also includes factors on the supply side of the service such as temporary closure due to the spread of infection among facility staff and users.…”