Factors associated with long-term care certification in older adults: a cross-sectional study based on a nationally representative survey in Japan

Abstract

Background Long-term care (LTC) prevention is a pressing concern in ageing societies. To understand the risk factors of LTC, it is vital to consider psychological and social factors in addition to physical factors. Owing to a lack of relevant data, we aimed to investigate the social, physical and psychological factors associated with LTC using large-scale, nationally representative data to identify a high-risk population for LTC in terms of multidimensional frailty. Methods We performed a cross-sectional study using anonymised data from the 2013 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare of Japan. Among the 23,730 eligible people aged 65 years or older and those who were not in hospitals or care facilities during the survey, 1718 stated that they had LTC certification. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with LTC certification. Results Factors positively associated with LTC certification in the multivariate analyses included older age, the interaction term between sex and age group at age 85–89 years, limb movement difficulties, swollen/heavy feet, incontinence, severe psychological distress (indicated by a Kessler Psychological Distress Scale [K6] score ≥ 13), regular hospital visits for dementia, stroke, Parkinson’s disease, chronic obstructive pulmonary disease, fracture, rheumatoid arthritis, kidney disease, diabetes and osteoporosis. Factors negatively associated with LTC certification included the presence of a spouse, regular hospital visits for hypertension and consulting with friends or acquaintances about worries and stress. Conclusions In summary, we identified the physical, psychological and social factors associated with LTC certification using nationally representative data. Our findings highlight the importance of the establishment of multidimensional approaches for LTC prevention in older adults.

Associations of polypharmacy and drugs with sedative or anticholinergic properties with the risk of long‐term care needs certification among older adults in Japan: A population‐based, nested case–control study

“…| 499 LTC certification. [25][26][27] Third, we re-quantified the cumulative dose of drugs with sedative or anticholinergic properties using the calculation formula of the Drug Burden Index. 22 Fourth, to further reduce potential bias due to reverse causality, we excluded prescriptions during the 18 months preceding the index month (i.e.…”

“…First, we controlled for baseline comorbidity measured by the Charlson Comorbidity Index instead of a list of 22 medical diagnoses 24 . Second, we added baseline psychiatric services and antidepressant use as covariates to control for possible confounding by indication: older adults with chronic mental health conditions, depression or dementia with behavioral problems might have a greater risk of receiving drugs with sedative or anticholinergic properties and LTC certification 25–27 . Third, we re‐quantified the cumulative dose of drugs with sedative or anticholinergic properties using the calculation formula of the Drug Burden Index 22 .…”

Escalation on Kihon Checklist Scores Preceding the Certification of Long-Term Care Need in the Older Population in Japan. A 9-Year Retrospective Study

“…We need to examine the trajectory of KCL scores in individuals who were certified to need LTC by 75 years of age, although older age is associated with LTC need certification. 28 Additionally, our study was conducted in a small city in a rural area with heavy snowfall in Japan. Therefore, making generalizations should be made cautiously.…”

Differential Associations of Frailty with the Incidence of Mild and Severe Disabilities in Older Adults: A 3-Year Cohort Study

“…For example, other comorbidities (e.g., dementia and stroke) and social factors are reportedly associated with the incidence of disability. 25 , 26 ) We could not obtain this information because this study was retrospective and used health examination data from the local government. Third, our results might have underestimated the incidence of disability since it is a factor that is strongly associated with death.…”