Patterns of long-term care service use and multimorbidity in older Japanese adults: A cross-sectional study of claim data.

AIM: The long-term care (LTC) insurance system provides a combination of several services in Japan; therefore, it is important to clarify service utilization. Furthermore, it is important to consider multimorbidity among older adults, who frequently present several diseases. This study aimed to clarify LTC service utilization patterns, including those for newly added multifunctional services, and to describe the basic characteristics, including multimorbidity, of these patterns. METHODS: We included 37 419 older adults in care need levels 1-5, living at home, who used LTC services in October 2017. We used LTC and medical claims data that were linked using unique identifiers from the National Health Insurance, Advanced Elderly Medical Insurance, and LTC Insurance of Shizuoka Prefecture in Japan. LTC service utilization patterns were identified using cluster analysis based on service fees. Multimorbidity was analyzed using the Charlson Comorbidity Index (CCI) and compared characteristics in these patterns. RESULTS: Six LTC service utilization patterns were identified: light use (51.0%), intensive use of day care (33.7%), intensive use of short stay (6.3%), intensive use of home help (5.1%), multifunctional LTC in small-group homes (MLS) use (3.7%), and MLS and home-visiting nurses (MLSH) use (0.2%). MLSH use had the highest CCI (3.6 ± 2.3). Intensive use of day care and short stay had the lowest CCI (2.6 ± 1.9). CONCLUSIONS: The characteristics of multimorbidity differed by LTC service utilization patterns. Our findings are useful for considering service utilization that takes into account the characteristics of older adults. Geriatr Gerontol Int 2024; 24: 283-289.

Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study.

INTRODUCTION: Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life. DESIGN: This was a retrospective cohort study. METHODS: We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use. RESULTS: Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). CONCLUSION: Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. CLINICAL RELEVANCE: When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.

Gradient boosting decision tree becomes more reliable than logistic regression in predicting probability for diabetes with big data.

We sought to verify the reliability of machine learning (ML) in developing diabetes prediction models by utilizing big data. To this end, we compared the reliability of gradient boosting decision tree (GBDT) and logistic regression (LR) models using data obtained from the Kokuho-database of the Osaka prefecture, Japan. To develop the models, we focused on 16 predictors from health checkup data from April 2013 to December 2014. A total of 277,651 eligible participants were studied. The prediction models were developed using a light gradient boosting machine (LightGBM), which is an effective GBDT implementation algorithm, and LR. Their reliabilities were measured based on expected calibration error (ECE), negative log-likelihood (Logloss), and reliability diagrams. Similarly, their classification accuracies were measured in the area under the curve (AUC). We further analyzed their reliabilities while changing the sample size for training. Among the 277,651 participants, 15,900 (7978 males and 7922 females) were newly diagnosed with diabetes within 3 years. LightGBM (LR) achieved an ECE of 0.0018 ± 0.00033 (0.0048 ± 0.00058), a Logloss of 0.167 ± 0.00062 (0.172 ± 0.00090), and an AUC of 0.844 ± 0.0025 (0.826 ± 0.0035). From sample size analysis, the reliability of LightGBM became higher than LR when the sample size increased more than [Formula: see text]. Thus, we confirmed that GBDT provides a more reliable model than that of LR in the development of diabetes prediction models using big data. ML could potentially produce a highly reliable diabetes prediction model, a helpful tool for improving lifestyle and preventing diabetes.

Care needs level in long-term care insurance system and family caregivers' self-perceived time-dependent burden in patients with home palliative care for cancer: a cross-sectional study.

PURPOSE: Although home care improves patients' quality of life (QOL), several studies have suggested that home care lowers the QOL of family caregivers and decreases their mortality. To alleviate the deleterious impact of home care on caregivers, the major burdens on caregivers and the clinical characteristics of the caregivers vulnerable to the major burden needs to be clarified. METHOD: A survey questionnaire was distributed to 710 family caregivers of patients with cancer in Japan, and 342 valid responses were obtained (valid response rate: 48.2%). The Burden Index of Caregivers was used to identify the major burden on caregivers. To assess the associations of the patients' care needs level and other clinically relevant factors with the major burden, a multivariable-adjusted logistic regression model was used. RESULTS: The time-dependent burden was identified as a major burden. An adjusted model showed a nonlinear association between the care needs level and the time-dependent burden, in which the caregivers of the patients who required moderate care needs level had the highest time-dependent burden [adjusted odds ratio of none, mild, moderate, and severe care needs levels: 0.50 (95% confidence interval 0.07-2.12), 1.08 (0.43-2.57), 1.87 (1.01-3.52), and 1.00 (reference), respectively]. Additionally, older patients and younger caregivers were significantly associated with a time-dependent burden. CONCLUSION: The time-dependent burden was highest in caregivers at the moderate care needs level and younger caregivers. An imbalance between the demand and supply of care services may be improved by considering the clinical characteristics of both patients and caregivers.

Factors related to preference for participation and degree of commitment in community activities among older adults in Japanese depopulated areas.

To address the rapid increase in the ageing population, Japan implemented the Long-Term Care Insurance System (LTCS) in 2000. Additionally, a community-based integrated community care system was released in 2012. The purpose of these policies was to help older people who need care or support to continue to live their preferred lifestyles in their own communities. According to this paradigm, older residents are themselves considered members of the community caregiving team and expected to participate in volunteer activities to help the neighbourhood. One such activity is social participation including community activities. Many factors influencing social participation have been found in previous literature. However, knowledge of specific factors about community activities is limited, even though these kinds of activities have attracted policy attention. Our study examined factors related to thoughts about community activities among people aged >40 years. We conducted random sampling in two depopulated areas in Japan and used an anonymous mail survey method. Our survey consisted of three parts: social demographics, health and life, and medical/long-term care. A total of 2,466 individuals participated in the study (response rate 52.2%), whose average age was 64.2 (SD = 10.3) and 46.5% (n = 1,146) were female. Items including talking with neighbours frequently (social demographics), higher self-rated health (health and life), the need for health consultations and the desire to take care of family members when they need help (medical/long-term care) were significantly related to both preference for participation and degree of commitment in community activities. To encourage participation in community activities among older citizens, we recommend interventions related to health literacy and family ties.

Quality and cost-effectiveness analyses of home-visit nursing based on the frequency of nursing care visits and patients' quality of life: A pilot study.

AIM: This pilot study aimed to analyze the cost-effectiveness of visiting nursing care, to establish a new evaluation method considering both the quality and cost of visiting nursing care. METHOD: Participants were 384 caregivers from 10 certified home-visit nursing agencies that support patients in severe conditions in Japan. They completed a survey assessing the number of nursing care visits carried out in November 2016, visiting nursing receipt data for 1 month of study and quality of life (QOL), as measured by the EuroQol-5 Dimension at their last visit, which took place 1 month later. RESULTS: We categorized participants into low-charge and high-charge groups. In the low-charge group, no relationship was found between high QOL and frequency of implementation of each type of care. In the high-charge group, participants with high frequencies of "medicine management and instruction," "description and guidance for diseases and treatment," and "nutrition and diet care" had higher levels of QOL. CONCLUSIONS: This research might contribute to establishing a cost assessment system for home-visit nursing care in Japan, which is expected to be useful in countries where the average age of the population is increasing. Care provided by visiting nurses might be divided into care items that related or did not relate to QOL. Therefore, when evaluating the quality and cost-effectiveness of visiting nursing care, it is necessary to construct an evaluation system that considers these aspects and obtain appropriate data. Geriatr Gerontol Int 2020; 20: 36-41.

Survey on the use of health consultation services provided in a Japanese urban public housing area with a high elderly population.

OBJECTIVE: The aim of the present study was to determine how the elderly in an urban public housing area intends to utilize health consultation services. METHODS: In December 2011, a cross-sectional posting survey was carried out on 2000 randomly selected elderly residents in an urban public housing area in Japan. The survey included information on the intention of use of health consultation services provided in the community, demographic background, living situation, medical and social care situation, and the concerns and desires about the services. RESULTS: We received 553 responses from the survey. Of the 534 responders who had never used the service, 150 (28.1%) intended to use, 313 (58.6%) were undecided and 71 (13.3%) expressed having no intention to use. Binominal logistic regression analysis showed that individuals who intended to use it tended to have the following features: aged ≥70 years (OR 2.35, 95% CI 1.41-3.93), resident of the complex for <10 years (OR 1.94, 95% CI 1.15-3.27), low sense of well-being (OR 3.69, 95% CI 1.03-13.26), family-related stress (OR 1.72, 95% CI 1.01-2.93), outpatient of internal medicine (OR 1.74, 95% CI 1.10-2.75), outpatient of cancer treatment (OR 2.58, 95% CI 1.15-5.77), history of unpleasant medical experience (OR 1.68, 95% CI 1.03-2.73), desire for a free health consultation (OR 1.80, 95% CI 1.07-3.04), desiring to consult about diseases (OR 2.01, 95% CI 1.27-3.18) and desiring to consult about caregiving (OR 1.64, 95% CI 1.05-2.56). CONCLUSION: Approximately 30% of residents had the intention of using the health consultation services provided in the community. The people who were more likely to use the services tended to have more intensive consultation support.

Determinants of financial performance of home-visit nursing agencies in Japan.

BACKGROUND: Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. METHODS: We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). RESULTS: Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. CONCLUSIONS: The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Associations between Japanese people's concern about family caregiver burden and preference for end-of-life care location.

Through a cross-sectional nationwide survey, this study identified the associations between Japanese people's choice of end-of-life care location and their sense of being a burden or a source of concern to their family members. A total of 1,042 people responded to the survey (a response rate of 55 percent). Of these, 44 percent said they would prefer to receive end-of-life care at home, 15 percent in hospital, 19 percent in a palliative care unit, 10 percent in a public nursing home, and 2 percent in a private nursing home. Multinomial logistic regression analysis revealed that those who thought it most important to relieve caregiver burden on family members tended to prefer a palliative care unit or a public nursing home to their own homes; those who were most concerned about the effect their death would have on their family members tended to prefer a hospital or a palliative care unit to their own homes. These findings may assist in the development of a more effective end-of-life care system in Japan and in other countries.

[The need for health consultation services and related factors among non-users of health consultation services residing in urban public apartment complexes].

OBJECTIVES: The aim of this study was to identify the factors associated with the need for health consultation services among non-users of such services within residents of urban public apartment complexes. METHODS: In December 2011, a cross-sectional mail survey was conducted with the inclusion of 2,000 elderly residents, randomly selected from a total of 6,000 residents. We asked about the need for health consultation services, demographic data, daily living situation, medical and care-giving experiences, and health concerns and desires. Data were analyzed using ordinal logistic regression analyses. RESULTS: A total of 534 questionnaires were analyzed from the 553 respondents (response rate 27.7%). Respondents expressed need for health consultation services: very important 21.5%; important 38.2%; unknown 19.1%; not so much important 14.0%; unimportant 6.9%. The analyses revealed that people with greater need tended to have the following features compared to those with less need: lack of independence in daily activities (P=.03), experiencing stress in family relationships (P=.003), having nurses to consult about health concerns (P=.04), do not necessarily need doctor's consultation regarding their health problems (P<.001), feel it difficult to consult doctors when they have health-related questions (P=.007), know about locally-available health consultation services (P=.02). They also wanted to use services they can visit accompanied by acquaintances (P=.002), with one-on-one health consultation regarding their problems (P=.003), where service is free (P=.008), where they receive advice about their illnesses (P<.001) and about their medical and caregiving cost (P=.008), and maintain contact with others using the services (P<.001). CONCLUSION: Although the response rate was low, most of residents expressed a need for a health consultation service. Based on the results of this study, a health consultation service provided by nurses may be an effective solution. They also desire the services to be accessible in the company of their acquaintances, provided one-on-one, free of charge, and to provide opportunities not only for consultation concerning their illnesses but also for interaction with others.

Associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services.

PURPOSE: The aims of this study were to identify the associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services. METHODS: A secondary analysis of a cross-sectional nationwide survey was conducted for 2000 randomly selected Japanese people aged 40-79 years. RESULTS: A total of 1042 people (55%) responded. Regarding preferred place of care, we set the place within the choices of "Home" (preferred by 44% of respondents), "Acute Hospital" (15%), "Palliative Care Unit" (19%), "Public Nursing Home" (10%), and "Private Nursing Home" (2%). Multinomial logistic regression analysis revealed that the people who preferred "Acute Hospital" tended to have the following need compared to those who preferred "Home," "Palliative Care Unit," or "Nursing Home": higher need for receiving end-of-life care not from its experienced professionals but from the same staff; higher need for using health care services in highly supported environment such as the need for being near health care staff whenever and for receiving treatment possibly until the end; and higher need for consulting nurses whenever. They had lower need for using home care services and daycare services and also lower need for instructing families about how to use insurance/public health services. CONCLUSIONS: The present findings may help to develop an effective end-of-life care system in Japan considering Japanese people's need for health care services. Also, the results of this study may underscore the importance of education on receiving home care services especially for the people who presently prefer the hospital for end-of-life care.

Japanese people's preference for place of end-of-life care and death: a population-based nationwide survey.

CONTEXT: Japanese people's preferred place of end-of-life care may be affected by their experiences, perceptions, and knowledge related to the end of life. OBJECTIVES: The aims of this study were to clarify the Japanese population's preferences for the place of end-of-life care and death and to identify the determinants of each choice of preferred place of end-of-life care within their experiences, perceptions, and knowledge. METHODS: A total of 2000 Japanese people aged 40-79 years participated in a cross-sectional nationwide survey. RESULTS: Fifty-five percent (n=1042) responded. Regarding place of end-of-life care, approximately 44% of the general population preferred home, 15% preferred hospital, 19% preferred palliative care unit, 10% preferred public nursing home, 2% preferred private nursing home, and the remaining 11% was unsure. Multinomial logistic regression analysis revealed that the following factors affect people's preferences regarding place of care: 1) experiences, such as "visiting hospital regularly" and "experiencing home death of relatives," 2) perceptions, such as "giving due thought to their own death on a daily basis" and "perceiving lower home palliative care costs to be appropriate after comparing hospital admission fees," and 3) knowledge of "home care nursing" and "24-hour home palliative system by physicians and nurses using insurance." These factors correlated with preference for hospital, palliative care unit, or public nursing home, when compared with the preference of home. CONCLUSION: The present findings may help to develop an effective end-of-life care system in Japan, in line with people's various preferred locations for such care.