Current Status of Long-term Care in Taiwan: Transition of Long-term Care Plan From 1.0 to 2.0

Changes in the Place of Death and Implications for End-of-Life Care Policy: A Population-Based Observational Study

Background: Death in hospital rather than at home is becoming more prevalent, even among terminally ill patients receiving home-based care. Identifying trends in places of death is crucial to care policy, especially for aging populations as in Taiwan. Aim: To identify changes in the places of natural death of Taiwanese individuals for various causes of death. Design: A population-based observational study was conducted. Setting: Anonymous data for the period 2000-2020 from the Death Database of Taiwan's National Center for Health Statistics Data were obtained and analyzed. Results: In 2000, 60.1% of natural deaths occurred in the home, whereas in 2020, this percentage was only 36.8%; conversely, the percentage of deaths in hospital increased from 34.4% in 2000 to 56.1% in 2020. Deaths in a nursing home or long-term care facility were found to account for only 3.8% of all natural deaths in 2020. Dementia was the cause of death for which the proportion of institutional deaths was highest, although this proportion was <10% for most years. We applied the joinpoint regression model to estimate trend changes in places of death. During the study period, the places of death in Taiwan changed significantly, the average annual percent changes for hospital deaths over the 21-year period was 2.54% (confidence interval [CI]: 2.04 to 3.03), and for home deaths was -2.69% (CI: -3.26 to -2.13). Conclusions: The detailed findings of this national study can offer insight into potential future clinical burdens and lead to better health policy decisions for Taiwan.

Applying Apriori algorithm to explore long-term care services usage status-Variables based on the combination of patients with dementia and their caregivers

Purpose

The aim of this study was to identify the combination of patients with dementia and their caregivers' characteristics associated with long-term care (LTC) services usage.

Patients and methods

A cross-sectional study was conducted with 475 patients with mild, moderate, and severe dementia at Changhua Christian Hospital, Taiwan. Eleven types of variables from patients with dementia, nine types of variables from patients' caregivers, and 15 types of LTC services were used for this study. The Apriori algorithm was employed to identify the attributes from the patients and their caregivers who used a particular LTC service from a comprehensive viewpoint.

Results

A total of 75 rules were generated by the Apriori algorithm with support of 2%, confidence of 80%, and lift >1. Among these rules, 25 rules belonged to home personal care services which were summarized further into four general rules for home personal care services. On the other hand, 50 rules belonged to assistive devices that were summarized further into 21 general rules based on their similarities. Patient's walking ability, patient's emotional liability, unemployed or retired caregivers, caregivers' feelings with either helplessness or hopelessness, and caregivers who cared for patients with dementia solely were found to be the critical variables to use home personal care services. In contrast, patient's walking ability, age, and severity as well as caregivers' age, mood, marital status, caregiving burden, and the patient being cared for mainly by a foreign care helper were found to be the critical variables to use assistive devices.

Conclusion

This study showed preliminary results on the LTC service usage from patients with dementia and their caregivers residing in the community. Understanding the patient-caregiver dyad's profile leads the service providers, policymakers, and the referral team to tailor service provisions better to meet the needs and identify the potential target groups. The findings in this study serve as references to reduce caregivers' burden as well as to improve the quality of care for patients with dementia.

Retrospective Evaluation of Discharge Planning Linked to a Long-Term Care 2.0 Project in a Medical Center

BACKGROUND

Although there are several studies on discharge planning and long-term care systems in individual programs, research on the connection between discharge planning and the usage of long-term care is scanty. This study aims to evaluate the nature of the association between discharge planning (DP) and long-term care (LTC) and whether the utilization of LTC services improved after being discharged.

METHODS

This was a single-center retrospective medical record review study. Secondary data analysis was conducted of DP-LTC participation data between 2018 and 2019. The objectives were to clarify the distinct characteristics of each part of the service to explore the utility rate by overall users and users with willingness and to determine the factors influencing their usage. Medical claims were used to identify inpatients receiving discharge services, and data were matched with LTC system engagement data (n = 2155). Backward stepwise regression was used to explore the attributes associated with each type of service use.

RESULTS

A total of 94% (2042/2155) of inpatients expressed a perceived need for LTC services, of which 14% (285/2042) were users of LTC services after discharge. When assessed by case-mix system (CMS) and willingness to use services during hospitalization, inpatients had higher rates of service utilization after discharge. Using LTC services was most likely to be associated with obesity, disability, high CMS level, higher education, and women.

CONCLUSION

The study confirms that the utilization of LTC services has improved under the integrated DP-LTC system. The gap between willing and actual users is worth considering. In the assessment stage, special attention should be paid to the service needs of persons with BMI ≥ 27 and disabilities. Future research with a larger sample could comprehensively evaluate the impact of integrated DP services on the use of LTC 2.0 service resources.

Approaching person-centered long-term care: The trajectories of intrinsic capacity and functional decline in Taiwan

AIM

To examine the longitudinal trajectory of intrinsic capacity over a 3-year period among long-term care recipients in Taiwan, its association with functional decline and the onset of severe dependency.

METHODS

A total of 9448 individuals aged ≥50 years utilizing home and community-based long-term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed-effects model to investigate their impact on activities of daily living and a Kaplan-Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes.

RESULTS

The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory-dysfunction" (29.53%) and "all-dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from -16.94 to -6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all-dysfunction class.

CONCLUSIONS

Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person-centered care approach in long-term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function-centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; ••: ••-••.

Impact of Using the Intelligent Physical Health Measurement System on Active Aging: A Survey in Taiwan

BACKGROUND

In Taiwan, the Chiayi City Government and Industrial Development Bureau of the Ministry of Economic Affairs have worked together to promote smart health management in the community and encourage people to use the intelligent physical health measurement system (IPHMS) with Smart Body Health Measuring Machine. Volunteers help participants in the community to use the IPHMS to ensure that measurements are taken correctly.

OBJECTIVES

This study aimed to explore volunteers' satisfaction with using the IPHMS and the effects of the measurement service on the participants' measurement behavior intention, and further explore the impact on their active aging.

METHODS

This study used a paper questionnaire to survey both the participants of the measurement service and the community volunteers from March to April 2021. A total of 180 valid responses were collected.

RESULTS

The sociodemographic information showed that the volunteers were mostly female, were aged over 61 years old, had received junior college education, had spent less than 3-6 years in community service, and had 6 months to 1 year of measured service experience. Additionally, the participants of the measurement service were mostly female, were aged over 61 years old, had received below middle school education, had spent less than 1-3 years in community service, and spent an average of 5 days in the community each week. Our results showed that the information quality (β = 0.352, p < 0.001) and system quality (β = 0.701, p < 0.001) had significant effects on volunteers' satisfaction of using the IPHMS. Subjective norms had significant effects on participants' perceived disease threat (β = 0.347, p < 0.001) and behavior intention of management service (β = 0.701, p < 0.001); furthermore, behavior intention had significant effects on their social participation for active aging (β = 0.430, p < 0.05).

CONCLUSIONS

Improving the system and information quality is likely to improve volunteers' satisfaction with the system. Active aging factors only affect social participation, which represents the measurement services promote for social interaction mostly.

Research on Disability Grading Based on ICF Functional Framework: Empirical Evidence From Zhejiang Province, China

Through assignment method, the total score of disability in multiple dimensions is obtained, and it is divided into five functional states—severe disability, partial disability, moderate disability, mild disability, and health—according to the score, and the probability of death is constructed. Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database tracking survey data, by constructing a multistate transition probability matrix, the empirical calculation of the multistate disability transfer probability, with the help of the sixth national census data, we estimated maintenance time of each state, life expectancy, etc. The results show that the 3 year transfer probability of the initial healthy elderly is the highest, and the mortality rate is also the lowest. It can be found that the disability state transition probability measurement based on the data is more accurate than the model estimation; the disability scale and life expectancy estimated based on the multistate transition probability matrix are more reliable.

Patterns of home- and community-based services in older adults with dementia: an analysis of the long-term care system in Taiwan

Background

Understanding the specific characteristics of the patients with dementia is essential in developing services required to meet their needs. The purpose of this study was to investigate the patterns of use of home- and community-based services (HCBS) by patients with dementia and the factors influencing the utilisation of these services.

Methods

We analysed a dataset of patients with dementia receiving long-term care at a medical centre. All participating patients were required to complete a structured interview form every 6 months to assess their need for service utilisation. Between 2015 and 2018, a total of 822 patients fulfilled the criteria for dementia, and 737 people had assessment records, of whom 244 had used social services. Robust Poisson regression analyses were performed to estimate HCBS usage and the factors influencing service utilisation.

Results

The overall service utilisation rate was 33 %. Most patients used only one service, and assistive devices were used as the main service. Regarding the factors influencing service use, dementia concomitant with dependency increased the use of HCBS. These results suggest that patients with mild dependency might prefer to use community support services, whereas those with moderate to severe dependency being more likely to utilise in-home care services.

Conclusions

This study provides empirical evidence regarding the use of long-term care resources by patients with dementia in the community. Providing customised HCBS, rather than a non-specialised service assumed to be suitable for every patient, is essential for ensuring good patient care. In addition, attention needs to be paid to patients with care needs who do not use HCBS.