Correlation between the Barthel Index and care need levels in the Japanese long‐term care insurance system

Matsuda, Tomoyuki; Iwagami, Masao; Suzuki, Toshiki; Jin, Xueying; Watanabe, Taeko; Tamiya, Nanako

doi:10.1111/ggi.13777

Cited by 46 publications

(48 citation statements)

References 3 publications

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“…Because the Japanese social care insurance system has improved over the years, this might have contributed to the present results differing from that reported by Mendiondo et al . back in 2000 . In the present study, the proportion of DS users was significantly smaller in patients with mild AD than in those with moderate or moderate‐to‐severe AD.…”

Section: Discussionmentioning

confidence: 41%

“…A significant difference in the annual score change on the HDS-R was found for the moderate-to-severe (<10) versus mild (>18) groups, but this significant difference was not observed between the other groups (Table 4). A significant difference in the annual score change on the MMSE was found for the moderate-to-severe (<16) versus moderate (17)(18)(19)(20)22) groups and the moderate-tosevere (<16) versus mild (>20) groups, but this significant difference was not observed between the moderate (17)(18)(19)(20)22) and mild (<20) groups (Table 4).…”

Section: Significant Differences Between the Moderate-to-severe And Mmentioning

confidence: 95%

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Medical interventions suppressed progression of advanced Alzheimer's disease more than mild Alzheimer's disease

Honjo¹,

Ide

Takechi

2020

Geriatrics Gerontology Int

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Aim Alzheimer's disease (AD) is the most common neurodegenerative disease. In 2000, Mendiondo et al. reported on a model predicting that AD progresses at an accelerating rate and cognitive function worsens rapidly. Recently, anti‐AD drugs and non‐pharmacological intervention have been established, but the effect of intervention is unclear and might depend on the stage of AD progression. Here, we examined the prediction of Mendiondo's model in patients with different severities of AD. Methods A total of 163 new outpatients with AD at four memory clinics were retrospectively analyzed. The Revised Hasegawa Dementia Scale (HDS‐R) and Mini‐Mental State Examination (MMSE) were administered to all AD patients at the first visit and after approximately 12 months. We divided the patients into three groups according to scores at the first visit: mild, moderate and moderate‐to‐severe. We compared the scores at the first visit with those obtained after 12 months of anti‐AD drug and non‐pharmacological interventions. Results The HDS‐R score improved from 14.5 to 15.0, and the MMSE score improved from 18.8 to 19.1 after 12 months of intervention. Also, the HDS‐R and MMSE scores at the first visit were significantly associated with the annual change in the scores. Among the three groups, lower HDS‐R and MMSE scores at the first visit were associated with significantly greater annual improvement in the scores after 12 months of intervention. Conclusions Contrary to the prediction of Mendiondo's model, mild or moderate AD progressed more rapidly than moderate‐to‐severe AD under pharmacological and non‐pharmacological interventions. Geriatr Gerontol Int 2020; 20: 324–328.

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Section: Discussionmentioning

confidence: 41%

Section: Significant Differences Between the Moderate-to-severe And Mmentioning

confidence: 95%

Medical interventions suppressed progression of advanced Alzheimer's disease more than mild Alzheimer's disease

Honjo¹,

Ide

Takechi

2020

Geriatrics Gerontology Int

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“…We used data from a self-administered questionnaire survey conducted in December 2016, the original purpose of which was to formulate a welfare plan for the older citizens in Tsukuba City, Ibaraki, Japan, while the data have been secondarily used for research [11,12]. This questionnaire was performed by postal delivery and collection.…”

Section: Data Sourcementioning

confidence: 99%

Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: a cross-sectional study in Japan

Suzuki

Iwagami

Hamada

et al. 2020

BMC Health Serv Res

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Background: Under the Japanese free access healthcare system, patients are allowed to consult multiple medical institutions (including clinics and hospitals for general or specialist consultation) without primary care referral. This potentially increases the risk of polypharmacy. We examined the association between the number of consulting medical institutions and polypharmacy under a healthcare system with free access. Methods: Via a self-administered questionnaire, we identified people aged ≥65 years with ≥1 disease and ≥1 consulting medical institution in a Japanese city in 2016. The exposure of interest was the number of consulting medical institutions (1, 2, or ≥3) and the outcome was polypharmacy (use of ≥6 types of drugs). We performed a multivariate logistic regression analysis, adjusting for age, sex, household economy, and the number and type of comorbidities. To minimize confounding effects, we also performed propensity-score-matched analysis, categorizing patients into two groups: 1 and ≥2 consulting medical institutions. Results: Of 993 eligible individuals (mean (standard deviation) age: 75.1 (6.5) years, men: 52.6%), 15.7% (156/993) showed polypharmacy. Proportions of polypharmacy were 9.7% (50/516), 16.6% (55/332), and 35.2% (51/145) for people who consulted 1, 2, and ≥3 medical institutions, respectively. Relative to people who consulted 1 medical institution, adjusted odds ratios (95% confidence intervals) for polypharmacy were 1.50 (0.94-2.37) and 3.34 (1.98-5.65) for those who consulted 2 and ≥3 medical institutions, respectively. In propensity score matching, of 516 and 477 patients who consulted 1 and ≥2 medical institutions, 307 pairs were generated. The proportion of polypharmacy was 10.8% (33/307) and 17.3% (53/307), respectively (P = 0.020). The odds ratio for polypharmacy (≥2 vs. 1 consulting medical institution) was 1.73 (95% confidence interval 1.09-2.76).

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“…First, the finding that the LTCI‐CNLs classification, an index of an objective assessment of care burden, has a moderate correlation with WHODAS 2.0 and SARC‐F scores suggests that the LTCI‐CNLs classification can be used as a proxy for determining perceived difficulty functioning in daily life and physical performance in patients who are cognitively functional enough to answer these questions. As the LTCI‐CNLs classification is a standardized index incorporated into the Japanese public long‐term insurance system, the LTCI‐CNLs classification could be used in several ways to improve health policy decision‐making and health service research 1,4,18,19 . For health service research, the LTCI‐CNLs classification could be used for casemix adjustment; 18 for example, to examine the effectiveness of specific medical procedures, such as management of oral hygiene, on mortality among older patients.…”

Section: Discussionmentioning

confidence: 99%

“…As the LTCI‐CNLs classification is a standardized index incorporated into the Japanese public long‐term insurance system, the LTCI‐CNLs classification could be used in several ways to improve health policy decision‐making and health service research 1,4,18,19 . For health service research, the LTCI‐CNLs classification could be used for casemix adjustment; 18 for example, to examine the effectiveness of specific medical procedures, such as management of oral hygiene, on mortality among older patients. In previous outcome studies that focused on preventing long‐term care and used population‐based approaches, support level 1 or higher was considered to represent a disability, 20,21 and CN level 3 or higher was considered to show a loss of independence 22,23 .…”

Section: Discussionmentioning

confidence: 99%

Validating care‐needs level against self‐reported measures of functioning, disability and sarcopenia among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study

Tsugihashi

Hirose²,

Iida

et al. 2021

Geriatrics Gerontology Int

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Aim This study aimed to examine the validity of the care‐needs levels classified in Japan's long‐term care insurance system (LTCI‐CNLs) when compared with patients’ self‐perceived functioning, disability and physical performance among patients receiving home medical care. Methods This was a multicenter cross‐sectional study in Japan. Patients who were receiving continuous home medical care and who could respond to the questionnaire were enrolled in this study. In addition to the LTCI‐CNLs, the 12‐item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the SARC‐F were used to measure functioning, disability and physical performance (sarcopenia). In addition, correlations and associations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were analyzed using Spearman correlations and linear mixed models. Results Data from 181 patients were included in the analyses. The LTCI‐CNLs varied, ranging from support level 1 (5.5%) to care‐needs level 5 (10.5%), with care‐needs level 2 being the most prevalent (24.9%). Moderate correlations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were found (ρ = 0.58 and 0.44, respectively). Although WHODAS 2.0 and SARC‐F scores varied within each LTCI‐CNL, predicted WHODAS 2.0 and SARC‐F scores increased as LTCI‐CNL increased. Dementia was not associated with WHODAS 2.0 or SARC‐F. Conclusions The LTCI‐CNLs was associated with self‐reported functioning, disability and physical performance among home medical care patients. Future studies can use the LTCI‐CNLs as an outcome variable for specific care approaches or as a proxy covariate for casemix status. Geriatr Gerontol Int 2021; 21: 229–237.

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Correlation between the Barthel Index and care need levels in the Japanese long‐term care insurance system

Cited by 46 publications

References 3 publications

Medical interventions suppressed progression of advanced Alzheimer's disease more than mild Alzheimer's disease

Medical interventions suppressed progression of advanced Alzheimer's disease more than mild Alzheimer's disease

Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: a cross-sectional study in Japan

Validating care‐needs level against self‐reported measures of functioning, disability and sarcopenia among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study

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