Association of long-term care needs, approaching death and age with medical and long-term care expenditures in the last year of life: An analysis of insurance claims data.

AIM: This study aimed to examine whether long-term care needs, approaching death and age were associated with the use of medical and long-term care resources (care/service use and expenditures) in the last year of life among older Japanese individuals. METHODS: Using data on insurance claims and death certificates, we described the use of medical and long-term care resources in the last year of life by residents of Soma City in Japan aged ≥65 years who died between September 2006 and October 2009. Using a generalized estimating equation, we examined whether long-term care needs, approaching death and age were associated with resource use during each 3-month period in the last year of life. RESULTS: Resource use in medical and long-term care among 882 non-survivors and 8504 survivors were analyzed. Analyses for the non-survivors showed statistically significant associations between: (i) severe long-term care needs and greater service use in outpatient care, higher expenditures for outpatient care and higher expenditures for in-home/facility services; (ii) approaching death and greater use in both inpatient care and facility services; and (iii) being aged 65-74 years and greater service use in outpatient/in-hospital care and in-home/facility services, higher expenditures in outpatient/inpatient care, and lower expenditures for in-home/facility services. CONCLUSIONS: The present study showed that severe long-term care needs and approaching death, rather than advancing age, were significantly and independently associated with greater use of resources in both medical and long-term care services. Geriatr Gerontol Int 2020; 20: 277-284.

Cumulative number of hospital bed days among older adults in the last year of life: A retrospective cohort study.

AIM: To determine whether age, proximity to death and long-term care insurance certification are related to receiving hospital inpatient care; the number of hospital bed days (HBD) among older Japanese adults in the last year of life; and to estimate the total number of HBD. METHODS: Using health insurance claims and death certificate data, the present retrospective cohort study examined the HBD of city residents aged ≥65 years who died between September 2006 and October 2009 in Soma City, Japan. Using a two-part model, factors associated with receiving hospital inpatient care and the total number of HBD in each quarter in the last year of life were examined. RESULTS: The total number of HBD in the last year of life varied widely; 13% had no admission, and 27% stayed ≥90 days. Younger age, approaching death and having long-term care insurance certification were significantly associated with being more likely to receive hospital inpatient care during each quarterly period in the last year of life. In contrast, having long-term care insurance certification and the last 3-month period before death, compared with the first 3-month period, were significantly associated with a fewer number of HBD. CONCLUSIONS: The present study showed that older age was associated with being less likely to receive hospital inpatient care. The findings regarding the risk of inpatient care and total number of HBD in the last year of life help to understand resource use among older dying adults, and to develop evidence-based healthcare policies within aging societies. Geriatr Gerontol Int 2017; 17: 737-743.

Significance of occlusal force for dietary fibre and vitamin intakes in independently living 70-year-old Japanese: from SONIC Study.

OBJECTIVES: The number of teeth has frequently been used as an indicator of oral health in investigations of food intake; however, this measure does not represent the efficacy of the masticatory performance. Masticatory performance may be more important for food selection and avoidance than number of remaining teeth. The aim of this study was to investigate the association of occlusal force with habitual dietary intakes in independently living older Japanese. METHODS: The study population was 757 community-dwelling people aged 69-71 years old. Bilateral maximal occlusal force in the intercuspal position was measured with pressure-sensitive sheets. Removable denture wearers kept their dentures in place during the measurements. Dietary habits during the preceding month were assessed using a brief-type self-administered diet history questionnaire that measures consumption frequencies of selected food commonly consumed and calculates energy-adjusted dietary intakes. Linear trends of food and nutrient intakes with decreasing occlusal force were tested after adjusting for gender and socioeconomic factors. RESULTS: After adjusting for socioeconomic status and the number of remaining teeth, decline of occlusal force was significantly associated with lower intakes of vegetables, vitamins A, C, B6, folate, and dietary fibre (P for trend<0.05). In contrast, number of teeth was significantly associated only with calcium and zinc, controlling for occlusal force. CONCLUSIONS: It is concluded that occlusal force was significantly associated with intakes of vitamins and dietary fibre rather than number of remaining teeth in independently living older Japanese.

[Development of a Japanese version of the Valuation of Life (VOL) scale].

This study developed a Japanese version of the Valuation of Life (VOL) scale, to measure psychological wellbeing among older adults. In Analysis 1, we conducted a factor analysis of 13 items, and identified two factors: positive VOL and spiritual well-being. These factors had adequate degrees of internal consistency, and were related to positive mental health. In Analysis 2, we examined sociodemographic, social, and health predictors for VOL. The role of social factors was stronger than the role of health factors, and spiritual well-being was more related to moral or religious activities than positive VOL. These results suggest that predictors for VOL vary by culture. In Analysis 3, we investigated the relationship between VOL and desired years of life. Positive VOL significantly predicted more desired years of life, whereas spiritual well-being did not. Positive VOL had acceptable reliability and validity. Future research is required to investigate whether VOL predicts survival duration or end-of-life decisions.

[Nutritional risk in community-dwelling elderly long-term care insurance recipients].

AIM: To define degree of nutritional risk in community-dwelling older disabled adults using translated Nutrition Screening Initiative (NSI) checklist and to identify important underlying factors associated with high nutritional risk. METHODS: Community-based studies were conducted in Katsushika, Tokyo and Odate and Tashiro, Akita. A total of 695 and 381 older adults, respectively, designated for long-term care insurance were interviewed. Nutritional risk was measured using the Japanese-translated NSI checklist. Demographic information, ADL, IADL, MMSE, CES-D, PGC morale scale, self-perceived health, loneliness, perceived caregiver's care burden, relationship with caregiver, perceived inadequacy of income, perceived burden of care cost were assessed using standardized instruments. RESULTS: Self-perceived health strongly related to high NSI score in both areas. Nutritional risk was considered 'high' when simply added NSI score was 3 points and over (NSI-10) and weighed NSI score was 6 points and over (NSI-21). Logistic regression analysis demonstrated that high levels of depression symptoms, poor self-perceived health, female and area (Odate/ Tashiro) were associated with NSI-10-based high risk and high levels of depression symptoms, smaller family member, perceived inadequacy of income and area (Odate/Tashiro) were associated with NSI-21-based high risk. These results were completely same when CES-D scores were replaced with PGC morale scale scores. CONCLUSION: It is concluded that emotional well-being is the important factor for maintaining nutritional environment in community-dwelling disabled older adults.

[Development of a portable fall risk index for elderly people living in the community].

AIM: To develop a portable risk index for falls. METHODS: Risk factors were chosen from previously established factors then we added several environmental factors to the risk index; previous falls in the last 12 month, trippig or stumbling, inability to ascend or descend stairs without help, decreased walking speed, inability to cross a road within the green signal interval, inability to walk 1km without a break, inability to stand on one leg for 5 seconds (eyes open), using a cane, inability to wring out a towel, dizziness or faintness, stooped or rounded back, knee joint pain, visual disturbance, hearing disturbance, cognitive decline, fear of falling, receiving 5 or more prescribed drugs, sensation of darkness at home, obstacles inside, barrier on the carpet or floor, using steps daily at home, steep slopes around home. SUBJECTS: The questionnaire sheet was completed by 2,439 community-dwelling elderly subjects (76.3 +/- 7.4 years old). The frequency of each items of fall risk index was compared between fallers (history of fall within one year) and non-fallers. Multiple regression analysis was performed to identify independent risk factors for previous falls. RESULTS: Except barrier, step use and steep slope around home, all items in the fall risk index were more frequent in fallers. Multivariate analysis revealed that tripping or stumbling, inability to cross a road within the green signal interval, dizziness or faintness, obstacles inside, inability to wring out a towel, cane use and knee joint pain were independent risk factors for previous falls. These 7 selected items were further analyzed as predictors. The maximum sum of sensitivity and specificity was reached at the cut-off point of 2/3 (sensitivity 0.65, specificity 0.72) by receiver operating curve. CONCLUSION: Portable fall risk index is useful for clinical settings to identify high-risk subjects.

The use of complementary and alternative medical therapies among older persons around the world.

Defining complementary and alternative medicine (CAM) helps in understanding what it offers, why older patients are attracted to and find effectiveness in these therapies, and how conventional practitioners can deal with their increasing use. The most common definition in United States medical literature is "those practices neither taught widely in United States medical schools nor gene-rally available in United States hospitals." Patient interviews must include inquiry into CAM use; providers need to know about potentially risky therapies. Integration of CAM into our health care system, although burdensome in the short term, will benefit patients in the long run, where benefit is due. Integration of CAM into treatment does not mean acknowledging its effectiveness, but taking advantage of any benefits it has to offer.

Assessments and nursing care for right brain-damaged stroke patients: focusing on neglect and related symptoms.

The purpose of present study was to identify the behavioural characteristics and examine assessments of nursing care among right brain-damaged stroke patients with neglect within 1 year following initial onset. Characteristics related to higher cerebral dysfunction were extracted and patient grouping was attempted through cognition (Mini-Mental State Examination) and physical function (Barthel Index) plots. The characteristics and implications for nursing care for each group were analyzed. Twelve patients were classified into four groups using cognitive-physical function evaluations together with subjective and objective data associated with neglect. 'Neglect' has been regarded as a disorder of spatial perception. However, the characteristics observed in Group 2 suggest that 'neglect' may have another facet, manifesting as disorders in perceiving continuous spatio-temporal changes of an action and comprehending the context of a situation. In these patients, although 'by calling attention' is the conventional care, more appropriate care should be provided based on an assessment of cognitive-physical function and spatio-temporal recognition of an action.