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Shimada H, Doi T, Tsutsumimoto K, Makino K, Harada K, Tomida K, Morikawa M, Arai H. Combined impact of physical frailty and social isolation on use of long-term care insurance in Japan: A longitudinal observational study. Maturitas 2024; 182:107921. [PMID: 38295504 DOI: 10.1016/j.maturitas.2024.107921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES The combined effect of physical frailty and social isolation on the need to make use of long-term care insurance (LTCI) among older adults remains unknown. Thus this study investigates the association between physical frailty, social isolation, and the use of LTCI among older adults in Japan. STUDY DESIGN This is a prospective observational study. MAIN OUTCOME MEASURES Physical frailty is defined as limitations in strength, mobility, and physical activity, as well as exhaustion and weight loss. People with one or two indicators were categorized as pre-frail. Participants with a score of 1 point or more on the social isolation scale were defined as being socially isolated. Participants were followed up monthly for two years to check whether incident certification of care had been required. RESULTS Data on 4576 community-dwelling independent older adults (mean age, 73.9 ± 5.5 years, 2032 men, 2544 women) were analyzed. A time-dependent Cox proportional hazards regression model showed that individuals with pre-frailty without social isolation (hazard ratio [HR] 2.02, 95 % confidence interval [CI] 1.40-2.91), pre-frailty with social isolation (HR 2.36, 95 % CI 1.62-3.43), frailty without social isolation (HR 2.98, 95 % CI 1.83-4.85), and frailty with social isolation (HR 3.19, 95 % CI 2.07-4.91) had significantly higher risks of needing to make use of LTCI than those with no frailty and without social isolation. This higher risk was non-significant among individuals with no frailty and social isolation (HR 1.28, 95 % CI 0.78-2.10). CONCLUSION Combined frailty and social isolation among older adults should be addressed to prevent adverse health outcomes, including use of LTCI.
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Affiliation(s)
- Hiroyuki Shimada
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan.
| | - Takehiko Doi
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Kota Tsutsumimoto
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Kouki Tomida
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
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Nakatsuka K, Ono R, Murata S, Akisue T, Fukuda H. Claims-based Frailty Index in Japanese Older Adults: A Cohort Study Using LIFE Study Data. J Epidemiol 2024; 34:112-118. [PMID: 36967119 PMCID: PMC10853043 DOI: 10.2188/jea.je20220310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/21/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND We aimed to assess whether the United States-developed Claims-based Frailty Index (CFI) can be implemented in Japanese older adults using claims data. METHODS We used the monthly claims data and certification of long-term care (LTC) insurance data of residents from 12 municipalities from April 2014 to March 2019. The 12 months from first recording was defined as the "baseline period," and the time thereafter as the "follow-up period". Participants aged ≥65 years were included, and those with no certified LTC insurance or who died at baseline were excluded. New certification of LTC insurance and all-cause mortality during the follow-up period were defined as outcome events. CFI categorization consisted of three steps including: 1) using 12 months deficit-accumulation approach that assigned different weights to each of the 52 items; 2) the accumulated score to derive the CFI; and 3) categorizing the CFI as "robust" (<0.15), "prefrail" (0.15-0.24), and "frail" (≥0.25). Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the association between CFI and outcomes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS There were 519,941 participants in total. After adjusting for covariates, the severe CFI category had a high risk of certification of LTC insurance (prefrail: HR 1.33; 95% CI, 1.27-1.39 and frail: HR 1.60; 95% CI, 1.53-1.68) and all-cause mortality (prefrail: HR 1.44; 95% CI, 1.29-1.60 and frail: HR 1.84; 95% CI, 1.66-2.05). CONCLUSION This study suggests that CFI can be implemented in Japanese claims data to predict the certification of LTC insurance and mortality.
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Affiliation(s)
- Kiyomasa Nakatsuka
- Kobe University Graduate School of Health Sciences, Kobe, Japan
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Rei Ono
- Kobe University Graduate School of Health Sciences, Kobe, Japan
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, National Institute of Health and Nutrition, Tokyo, Japan
| | - Shunsuke Murata
- Kobe University Graduate School of Health Sciences, Kobe, Japan
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | | | - Haruhisa Fukuda
- Kyushu University Graduate School of Medical Sciences, Department of Health Care Administration and Management, Fukuoka, Japan
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Watanabe T, Tamiya N. Utilization of Japanese long-term care-related data including Kaigo-DB: An analysis of current trends and future directions. Glob Health Med 2024; 6:63-69. [PMID: 38450118 PMCID: PMC10912809 DOI: 10.35772/ghm.2023.01135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
Despite high expectations from the government and researchers regarding data utilization, comprehensive analysis of long-term care (LTC)-related data use has been limited. This study reviewed the use of LTC-related data, including Kaigo-DB, in Japan after 2020. There was an increase in studies using LTC-related data in Japan between 2020 and 2021, followed by a stabilization period. The national government provided 13.5% of this data (6.5% from Kaigo-DB), while prefectures and municipalities contributed 85.2%, and facilities provided 1.3%. The linked data used in 90.4% of the studies primarily consisted of original questionnaire or interview surveys (34.6%) and medical claims (34.0%). None of the studies based on Kaigo-DB utilized linked data. In terms of study design, cohort studies were the most common (84.6%), followed by descriptive (5.1%), cross-sectional (3.2%), and case-control studies (1.3%). Among the 138 individual-based analytical descriptive studies, the most frequently used LTC-related data as an exposure was LTC services (26.8%), and the most common data used as an outcome was LTC certification or care need level (43.5%), followed by the independence degree of daily living for the older adults with dementia (18.1%). To enhance the use of LTC-related data, especially the valuable national Kaigo-DB, insights can be gleaned from how researchers effectively utilize municipal and prefectural data. Streamlining access to Kaigo-DB and enabling its linkage with other datasets are promising for future research in this field.
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Affiliation(s)
- Taeko Watanabe
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
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Chen LK, Iijima K, Shimada H, Arai H. Community re-designs for healthy longevity: Japan and Taiwan examples. Arch Gerontol Geriatr 2022; 104:104875. [PMID: 36443116 DOI: 10.1016/j.archger.2022.104875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
| | - Katsuya Iijima
- Institute of Gerontology, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Kato G, Doi T, Arai H, Shimada H. Cost-effectiveness Analysis of Combined Physical and Cognitive Exercises Programs Designed for Preventing Dementia among Community-dwelling Healthy Young-old Adults. Phys Ther Res 2022; 25:56-67. [PMID: 36118786 PMCID: PMC9437929 DOI: 10.1298/ptr.e10153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/28/2022] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aims to estimate the cost-effectiveness of combined physical and cognitive programs designed to prevent community-dwelling healthy young-old adults from developing dementia. METHODS The analysis was conducted from a public healthcare and long-term care payer's perspective. Quality-adjusted life years (QALYs) and expenses for health services and long-term care services were described in terms of effectiveness and cost, respectively. A thousand community-dwelling healthy adults aged 65 years were generated through simulation and analyzed. The incremental cost-effectiveness ratio (ICER) of adults with preventive program intervention compared to those with nonintervention was simulated with a 10-year cycle Markov model. The data sources for the parameters to build the Markov models were selected with priority given to higher levels of evidence. The threshold for assessing cost-effectiveness was set as less than 5,000,000 Japanese yen/QALY. RESULTS The ICER was estimated as -5,740,083 Japanese yen (US$-57,400)/QALY. CONCLUSION A program targeting community-dwelling healthy young-old adults could be cost-effective.
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Affiliation(s)
- Gohei Kato
- Department of Physical Therapy, School of Rehabilitation, Tokyo Professional University of Health Sciences, Japan
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
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Chen R, Zhao WB, Zhang XP, Liang H, Song NN, Liu ZY, Xiao H, Peng XT, Song Y, Liao RT, Luo WH, Wei L. Relationship between frailty and long-term care needs in Chinese community-dwelling older adults: a cross-sectional study. BMJ Open 2022; 12:e051801. [PMID: 35487750 PMCID: PMC9058676 DOI: 10.1136/bmjopen-2021-051801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our study aimed to investigate the relationship between the severity of frailty and the long-term care (LTC) needs of older adults from Chinese communities. DESIGN A cross-sectional study. SETTING Three Chinese community health centres. All data were collected by trained researchers through face-to-face collection. PARTICIPANTS We surveyed a total of 540 older residents who aged 60 or older from community in Guangzhou, China. MEASURES The Chinese version of the Tilburg frailty indicator was used to assess the frailty status of participants. LTC needs was evaluated by Integrated Home Care Services Questionnaire. Using non-adjusted and multivariate adjusted logistic regression analysis to evaluate frailty and LTC needs, then smoothed plots, threshold effect analysis and P for trend were used to further investigate the relationship between them. RESULTS The prevalence of frailty was 45.2% among the 540 older adults enrolled (aged 70.4±8.3 years; 65.7% females). 27% had higher LTC needs, which increased to 65.1% for individuals with frailty. Logistic regression analysis showed that frailty was strongly associated with LTC needs (OR 3.06, 95% CI 2.06 to 4.55, p<0.01). In the multivariate model, after adjusting for demographic characteristics, economic situation, activities of daily living and comorbidities, frailty remained significantly associated with LTC needs (OR 2.32, 95% CI 1.39 to 3.88, p<0.01). The smoothed plots showed a nearly linear relationship between frailty and LTC needs. Threshold effect analysis showed that every point increase in frailty, the score of LTC needs increased 1.3 points. The IQR to regroup individuals with frailty. Compared with the first quartile (scores ≤2), the incidence of LTC needs increased with the frailty status (p value for trend <0.01). CONCLUSION There is a linear relationship between frailty and LTC needs. With the increasing degree of frailty, the LTC needs of older adults dramatically increases.
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Affiliation(s)
- Rui Chen
- Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Neurology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Wen Bo Zhao
- Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao Pei Zhang
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Neurology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Liang
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Neurology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Na Na Song
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Neurology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhu Yun Liu
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Neurology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hui Xiao
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Nursing, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Xue Ting Peng
- Neurology, Foshan Hospital of TCM, Foshan, Guangdong, China
| | - Yang Song
- Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruo Tong Liao
- Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Neurology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Wang Hui Luo
- Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Lin Wei
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- Nursing, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
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Katayama O, Lee S, Bae S, Makino K, Chiba I, Harada K, Morikawa M, Tomida K, Shimada H. Association between Non-Face-to-Face Interactions and Incident Disability in Older Adults. J Nutr Health Aging 2022; 26:147-152. [PMID: 35166306 PMCID: PMC8783584 DOI: 10.1007/s12603-022-1728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This observational prospective cohort study, conducted between September 2015 and February 2019, aimed to investigate the association between the incidence of disability and non-face-to-face interactions among community-dwelling older adults in Japan. DESIGN Participants reported their interaction status using a self-report questionnaire. Face-to-face interactions comprised in-person meetings, while virtual interactions (e.g., via phone calls or emails) were defined as non-face-to-face interactions. We examined the relationship between their interaction status at baseline and the risk of disability incidence at follow-up. We also considered several potential confounding variables, such as demographic characteristics. SETTING The National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. PARTICIPANTS We included 1159 adults from Takahama City aged ≥75 years (mean age ± standard deviation = 79.5 ± 3.6 years). MEASUREMENTS Interaction status was assessed using a self-reported questionnaire consisting of two sections (face-to-face and non-face-to-face interactions), and four questionnaire items. Based on the responses we categorized study participants into four groups: "both interactions," "face-to-face only," "non-face-to-face only," and "no interactions." RESULTS Individuals with both kinds of interactions (49.3/1000 person-years) or only one kind of interaction (face-to-face = 57.7/1000 person-years; non-face-to-face = 41.2 person-years) had lower incidence of disability than those with no interactions (88.9/1000 person-years). Moreover, the hazard ratios adjusted for potential confounding factors for the incidence of disability in the both interaction, face-to-face-only, and non-face-to-face only groups were 0.57 (confidence interval = 0.39-0.82; p = 0.003), 0.66 (confidence interval = 0.44-0.98; p = 0.038), and 0.47 (confidence interval = 0.22-0.99; p = 0.048), respectively. CONCLUSION Considering the interaction status of older adults in their day-to-day practice, clinicians may be able to achieve better outcomes in the primary prevention of disease by encouraging older adults to engage in any form of interaction, including non-face-to-face interactions.
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Affiliation(s)
- O Katayama
- Osamu Katayama, National Center for Geriatrics and Gerontology, Obu City, Aichi Japan,
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Okamura T, Sugiyama M, Inagaki H, Miyamae F, Ura C, Sakuma N, Edahiro A, Taga T, Tsuda S, Awata S. Depressed mood and frailty among older people in Tokyo during the COVID-19 pandemic. Psychogeriatrics 2021; 21:892-901. [PMID: 34530494 PMCID: PMC8662134 DOI: 10.1111/psyg.12764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 07/22/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The study aim was to identify depressed mood and frailty and its related factors in older people during the coronavirus disease 19 pandemic. METHODS Since 2010, we have conducted questionnaire surveys on all older residents, who are not certified in the long-term care insurance, living in one district of Tokyo municipality. These residents are divided into two groups by birth month, that is those born between April and September and those born between October and March, and each group completes the survey every 2 years (in April and May). Study participants were older residents who were born between April and September and who completed the survey in spring 2018 and in spring 2020, the pandemic period. Depressed mood and frailty were assessed using the Kihon Checklist, which is widely used by local governments in Japan. We had no control group in this study. RESULTS A total of 1736 residents responded to both surveys. From 2018 to 2020, the depressed mood rate increased from 29% to 38%, and frailty increased from 10% to 16%. The incidence of depressed mood and frailty was 25% and 11%, respectively. Incidence of depressed mood was related to subjective memory impairment and difficulty in device usage, and incidence of frailty was related to being older, subjective memory impairment, lack of emotional social support, poor subjective health, and social participation difficulties. CONCLUSIONS Older people with subjective memory impairment may be a high-risk group during the coronavirus pandemic. Telephone outreach for frail older people could be an effective solution. We recommend extending the scope of the 'reasonable accommodation' concept beyond disability and including older people to build an age-friendly and crisis-resistant community.
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Affiliation(s)
| | - Mika Sugiyama
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Chiaki Ura
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Naoko Sakuma
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tsutomu Taga
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuji Tsuda
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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