Who Will Need Long-Term Care?: Creation and Validation of an Instrument that Identifies Older People at Risk

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study

Background

An ageing population and limited resources have put strain on state provision of adult social care (ASC) in England. With social care needs predicted to double over the next 20 years, there is a need for new approaches to inform service planning and development, including through predictive models of demand.

Objective

Describe risk factors for long-term ASC in two inner London boroughs and develop a risk prediction model for long-term ASC.

Methods

Pseudonymised person-level data from an integrated care dataset were analysed. We used multivariable logistic regression to model associations of demographic factors, and baseline aspects of health status and health service use, with accessing long-term ASC over 12 months.

Results

The cohort comprised 13,394 residents, aged ≥75 years with no prior history of ASC at baseline. Of these, 1.7% became ASC clients over 12 months. Residents were more likely to access ASC if they were older or living in areas with high socioeconomic deprivation. Those with preexisting mental health or neurological conditions, or more intense prior health service use during the baseline period, were also more likely to access ASC. A prognostic model derived from risk factors had limited predictive power.

Conclusions

Our findings reinforce evidence on known risk factors for residents aged 75 or over, yet even with linked routinely collected health and social care data, it was not possible to make accurate predictions of long-term ASC use for individuals. We propose that a paradigm shift towards more relational, personalised approaches, is needed.

Association of Instrumental Activities of Daily Living, Physical Function, and Mental Health among Older Returnees after the Fukushima Daiichi Nuclear Power Station Accident

The 2011 Great East Japan Earthquake and consequent Fukushima Daiichi Nuclear Power Station accident caused a large-scale evacuation, generating various health issues. Although residents gradually returned, their independence of daily living and associated factors remain unknown. This study examines the hypothesis that physical and mental status are associated with the instrumental activities of daily living (IADL) of older returnees (65 years and above) after the disaster. Older returnees to Kawauchi Village, Fukushima Prefecture, located 20–30 km southwest of the power plants, were recruited. IADL was assessed using the Japan Science and Technology Agency Index of Competence, physical function via the 30-s chair stand test, and mental health via the Japanese version of the World Health Organization Five Well-Being Index. To examine the association of IADL and possible factors, a t-test or Pearson’s product-moment correlation coefficient was used, stratified by sex. The data of 29 participants (75.5 ± 7.4 years, 19 female) were analyzed. Physical function was associated with IADL in females. Mental health was associated with IADL in males and females. Taking measures to strengthen physical function in females, as well as to improve mental health in both sexes, for enhancing IADL ability could be beneficial.

Association of Living in Evacuation Areas With Long-Term Care Need After the Fukushima Accident

OBJECTIVES

A previous report indicated that evacuation owing to the government order after the Fukushima disaster impacted the health status of older people; however, the association between living in evacuation areas and independence in their daily lives was unclear. This study examined the hypothesis that people who were forced to evacuate their homes were more likely to need long-term care (LTC).

DESIGN

Historical cohort study.

SETTING AND PARTICIPANTS

Older individuals (n = 13,934) in Minamisoma, Fukushima Prefecture, Japan, part of which was designated as an evacuation area.

METHODS

Background and certification data from April 2012 to December 2016 were extracted. Logistic regression analysis with sex stratification was performed to examine the association between certification of care levels 1-5 and living in evacuation areas.

RESULTS

In total, 18,178 Minamisoma residents aged ≥65 years who had not received LTC certification as of March 11, 2011, were eligible for follow-up. Of these, 4244 residents without a certificate of residence by June 1, 2016, were excluded. Of 13,934 residents followed up, 1553 (11.1%) were newly certified as care levels 1-5. Certification of care levels 1-5 was associated with living in evacuation areas [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.18] and living alone at the time of the disaster (OR 2.58, 95% CI 1.92-3.47) in men and living alone at the time of the disaster (OR 1.35, 95% CI 1.15-1.59) in women.

CONCLUSIONS AND IMPLICATIONS

Living in evacuation areas and living alone were associated with LTC certification. In evacuation areas, individuals with family members were more likely to be certified compared with those in nonevacuation areas. Among residents in evacuation areas, several individuals with family members experiencing family structure changes might need LTC. Preventive measures (including group relocation) may be beneficial for those being evacuated following a disaster.

Predictors of developing a new need for long-term care of older adults aged ≥70 years: Results from a population-based cohort study in Taiwan

AIM

To determine the characteristics associated with developing a new need for long-term care among older Taiwanese adults.

METHODS

We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging. A total of 1986 persons who were aged ≥70 years and had no disability in activities of daily living or need for long-term care at the baseline served as the study participants. We first identified the potential variables associated with developing a need for long-term care in demographic, socioeconomic, anthropometric, functional status, mental health, medical and global domains based on the literature and our earlier studies. We then carried out univariable logistic regression analyses to identify the variables most strongly associated with developing a new need for long-term care within each domain. Variables showing the strongest association were further analyzed in a forward stepwise multivariable logistic regression model to determine the significant predictors.

RESULTS

The multivariable model identified age, sex, doing heavy housework, walking 200 m, carrying out calculation, appetite status, frequency of hospitalizations during the past 12 months, living arrangement and weight loss as significant (P < 0.05) predictors.

CONCLUSIONS

The present study identified nine characteristics that predict the subsequent 4-year new need for long-term care of ≥70-year-old Taiwanese adults. Age, sex and functional status are the most powerful predictors. The results are useful for identifying older individuals at risk of developing a new need for long-term care within the next 4 years, enabling implementation of preventive strategies or timely care planning. Geriatr Gerontol Int 2019; 19: 641-646.

Validity of motor impairment scale in long-term care insurance system of Korea

OBJECTIVE

To validate the Motor Impairment Scale (MIS) of the Korean long-term care insurance (LTCI) system by comparing with the service time offered for aiding activities of daily living (ADL) and the ADL score.

METHODS

A total of 407 elderly subjects without dementia who had used LTCI services were included in this study. Spearman correlations and multivariate linear regression models were employed to determine the relationship of the upper and lower limb MIS (U-MIS and L-MIS, respectively) to the service time and ADL. Stratified analyses for the facility group (n=121) and the domiciliary group (n=286) were performed.

RESULTS

There were significant differences in characteristics between facility group and domiciliary group. The MIS was significantly correlated with service time in facility group (Spearman p=0.41 for U-MIS, Spearman p=0.40 for L-MIS). After adjusting for age, sex, and cognition score, U-MIS was an independent predictor for service time in facility group (p=0.04). In domiciliary group, no significant correlation was found between the MIS and service time. The MIS correlated with all of the ADL items and total ADL score in both groups. After adjusting for other factors including age, sex, and cognitive score, U-MIS and L-MIS were independent variables for explaining the total ADL score in both groups.

CONCLUSION

The validity of the MIS as an evaluation tool in the physically-disabled elderly is higher in facility group than in domiciliary group. As an easy, objective, and simple method, MIS can be a useful tool in the LTCI system of Korea.

Predicting who will use intensive social care: case finding tools based on linked health and social care data

BACKGROUND

the costs of delivering health and social care services are rising as the population ages and more people live with chronic diseases.

OBJECTIVES

to determine whether predictive risk models can be built that use routine health and social care data to predict which older people will begin receiving intensive social care.

DESIGN

analysis of pseudonymous, person-level, data extracted from the administrative data systems of local health and social care organisations.

SETTING

five primary care trust areas in England and their associated councils with social services responsibilities.

SUBJECTS

people aged 75 or older registered continuously with a general practitioner in five selected areas of England (n = 155,905).

METHODS

multivariate statistical analysis using a split sample of data.

RESULTS

it was possible to construct models that predicted which people would begin receiving intensive social care in the coming 12 months. The performance of the models was improved by selecting a dependent variable based on a lower cost threshold as one of the definitions of commencing intensive social care.

CONCLUSIONS

predictive models can be constructed that use linked, routine health and social care data for case finding in social care settings.

A short functional survey is responsive to changes in functional status in vulnerable older people

OBJECTIVES

To investigate whether an abbreviated five-item functional status survey consisting of five activities of daily living (ADLs) reflects changes measured over time in a full 12-item functional status survey.

DESIGN

Longitudinal evaluation with mean follow-up of 11 months.

SETTING

Two managed-care organizations in the United States.

PARTICIPANTS

Four hundred twenty community-dwelling older people at moderate to high risk of death and functional decline enrolled in the Assessing Care of Vulnerable Elders (ACOVE) observational study.

MEASURES

Number of ADL abilities according to the short (range 0-5) and full functional status surveys (range 0-12); change in function as defined according to a 1-point change in short score and 1- to 2-point change in full survey scores.

RESULTS

Changes in short functional status survey scores were highly correlated to changes in long survey scores (correlation coefficient=0.88). On average, a 1-point change in the short survey score was associated with a 1.4-point change on the long survey score (P<.001). The short survey correctly classified 93% of those who declined according to the long survey, adjusting for chance agreement (kappa=0.82) and was responsive to decline in function (sensitivity 82-94%, specificity 94-97%, and area under the receiver operating curve 0.91-0.93 for 1- to 2-point decreases in full survey ADL counts).

CONCLUSION

The short functional status survey is an efficient way to detect changes in functional status in vulnerable older populations for clinical and research purposes.