Aged care service delivery in Japan: preparing for the long-term care insurance scheme

<p>An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR)</p>

Purpose

Population ageing has been steadily rising in Iran and in the over 60-year-old population, the ratio increased from 5.4% in 1986 to 8.6% in 2016 which represents an increase of 4.3 million over the past three decades. The inevitable impacts of a growing elderly population on the demand-side of the health care provision (HCP) equilibrium call for an urgent revision of the current arrangements of the Iran’s National health care system (INHS). The main aim of this study was to scrutinize the best available scientific evidence on the international integrated elderly health care governance (HCG) models to revamp health care practice and policy-making processes in Iran.

Materials and Methods

This multiphasic study consists of a scoping review of existent HCP modalities for the elderly population worldwide, and the disposition of an optimal HCP scheme for the elderly population and its application for the detection of the gaps in Iran. The final stage includes a Delphi-based consultation and consensus process which was reciprocated in three rounds and the key subjects were requested to give their judgment on the eventuated HCP layout designed to serve the ageing Iranian population.

Results

The yielded model (IEHCG-IR) included four dimensions consistent with the four levels of prevention along with social support services. The structure and feasibility of the preliminary framework were approved by 83.6% of the study participants.

Conclusion

The study findings could have important implications for future policy making in the INHS and the suggested healthcare framework for the elderly Iranian population could be a preliminary model for health system re-engineering.

Development of a Japanese version of the care planning assessment tool

AIM

To develop a Japanese version of the Care Planning Assessment Tool (J-CPAT), originally developed in Australia as a comprehensive assessment of people with dementia.

METHODS

The process of adapting the CPAT into Japanese included translation into Japanese, assessment of item comprehension, and a validity and reliability study. The J-CPAT is composed of eight domains: Communication, physical problems, self-help skills, confusion, behaviour, social interaction, psychiatric observations and carer dependency. The participants were 199 aged care clients. Measures were the J-CPAT, Mini-Mental State Examination (MMSE) and Care Levels used in the Long-term Care Insurance scheme.

RESULTS

Cronbach's alpha values in each J-CPAT domain were 0.74-0.95. The correlation coefficient between the score of Confusion and MMSE was -0.90, and those between physical problems, self-help skills, carer dependency in the J-CPAT, and care level were 0.70, 0.75 and 0.67.

CONCLUSIONS

The J-CPAT appears to be a reliable and valid tool for care planning in Japan.