[Changes in roles and feelings among "Kaigoyobou leaders" responsible for community prevention activities over 10 years].

Objectives　Community residents experience changes over time, including those in the care prevention system, governmental expectations, and their motivations. To support community-based prevention activities, it is necessary to clarify these changes. This study used a qualitative research method to examine changes in roles and feelings among "Kaigoyobou leaders" who had been involved in community-based care prevention activities for 10 years.Methods　The study participants were nine leaders (six men and three women) who had been active in community-based care prevention for approximately 10 years. Through one-hour semi-structured interviews, we explored their current activities, reasons for taking the leader training course, changes in the content of their activities since completing the course, changes in their roles in activities and feelings about the activities, and what they recognized as important in their activities. Interviews were transcribed verbatim and analyzed using a modified grounded theory approach. From the transcripts, we extracted "concepts" related to changes among the leaders and generated "categories" to summarize the concepts.Results　The analysis identified 28 concepts summarized into 12 categories. The categories included: "belief in the activities" (e.g., "focusing on preventive effects"), "learning through trial and error" (e.g., "learning continuously"), "developing the activities" (e.g., "expanding the activities"), "commitment to the community" (e.g., "valuing connections with people involved in the activities"), "increasing required roles" (e.g., "taking consultations from juniors"), "relationship with the government" (e.g., "responding to requests from the government"), "benefits from the activities" (e.g., "receiving a sense of accomplishment and satisfaction from the activities"), "burden due to the activities" (e.g., "a shortage of group members"), "aging of stakeholders" (e.g., "increasing age of the participants"), "preparing for continuity" (e.g., "new people wishing to participate"), "considering ending activities" (e.g., "reducing activities due to increasing age of the leaders themselves"), and "impact of the coronavirus."Conclusion　Leaders' strong belief in their activities and their ability to adapt based on successful experiences were crucial. They responded effectively to environmental changes, including evolving government relationships. Fostering leadership belief, highlighting the benefits of activities, and supporting collaborative responses to environmental changes are essential for ongoing success.

Group-based trajectories of potentially preventable hospitalisations among older adults after a hip fracture.

Key predictors of three trajectory group membership of potentially preventable hospitalisations were age, the number of comorbidities, the presence of chronic obstructive pulmonary disease and congestive heart failure, and frailty risk at the occurrence of hip fracture. These predictors of their trajectory group could be used in targeting prevention strategies. PURPOSE: Although older adults with hip fracture have a higher risk of multiple readmissions after index hospitalisation, little is known about potentially preventable hospitalisations (PPH) after discharge. This study examined group-based trajectories of PPH during a five-year period after a hip fracture among older adults and identified factors predictive of their trajectory group membership. METHODS: This retrospective cohort study was conducted using linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2021. Patients aged ≥ 65 years who were admitted after a hip fracture and discharged between 2014 and 2016 were identified. Group-based trajectory models were derived based on the number of subsequent PPH following the index hospitalisation. Multinominal logistic regression examined factors predictive of trajectory group membership. RESULTS: Three PPH trajectory groups were revealed among 17,591 patients: no PPH (89.5%), low PPH (10.0%), and high PPH (0.4%). Key predictors of PPH trajectory group membership were age, number of comorbidities, dementia, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), frailty risk, place of incident, surgery, rehabilitation, and length of hospital stay. The high PPH had a higher proportion of patients with ≥ 2 comorbidities (OR: 1.86, 95% confidence interval (CI): 1.04-3.32) and COPD (OR: 2.97, 95%CIs: 1.76-5.04) than the low PPH, and the low and high PPHs were more likely to have CHF and high frailty risk as well as ≥ 2 comorbidities and COPD than the no PPH. CONCLUSIONS: Identifying trajectories of PPH after a hip fracture and factors predictive of trajectory group membership could be used to target strategies to reduce multiple readmissions.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in Japan: A retrospective propensity-matched cohort study.

OBJECTIVE: The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community. METHOD AND PATIENTS: Of the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score-matched cohorts (n = 214,723). Exclusion criteria included co-prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score-matched cohort without a prescription (control group). Participants were followed for more than 42 months. RESULTS: During the 42-month follow-up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all-cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023-1.146] for mortality, 1.117 [1.014-1.230] for aspiration pneumonia, and 1.720 [1.559-1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient-years, respectively. CONCLUSIONS: Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient-years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. CLINICAL TRIAL REGISTRATION: UMIN-CTR UMIN000048398.

The role of frailty risk for fracture-related hospital readmission and mortality after a hip fracture.

BACKGROUND: Frailty risk estimated using hospital administrative data may provide a useful clinical tool to identify older hip fracture patients at-risk of fracture-related readmissions and mortality. This study examined hip fracture hospitalisation temporal trends and explore the role of frailty risk in fracture-related readmission and mortality. METHODS: This retrospective cohort study was conducted using linked hospital admission and mortality data in New South Wales, Australia. Patients aged ≥65 years were admitted after a hip fracture between 2014 and 2021 for temporal trends and those admitted and discharged after a hip fracture in 2014-2018 for fracture-related readmission. The Hospital Frailty Risk Score was estimated, and patients were followed for at least 36 months after discharge. A semi-competing risk analysis was used to examine the associations of frailty with fracture-related readmission and/or mortality. RESULTS: Hip fracture hospitalisation rate was 472 per 100,000 and declined by 2.9 % (95 % confidence intervals (CI): -3.7 to -2.1) annually. Amongst 28,567 patients, 9.8 % were identified with low frailty risk, 39.4 %, intermediate frailty risk, and 50.6 % with high frailty risk. Patients with intermediate or high frailty risk had a higher chance of fracture-related readmission (Hazard ratios (HR): 1.33, 95 %CI: 1.21-1.47, HR: 1.65, 95 %CI: 1.49-1.83), death (HR: 1.50, 95 %CI: 1.38-1.63, HR: 1.80, 95 %CI: 1.65-1.96) and death post fracture-related readmission (HR: 1.32, 95 %CI: 1.12-1.56, HR: 1.56, 95 %CI: 1.32-1.84) than those with low frailty risk. CONCLUSIONS: It appears that frailty risk estimated using hospital administrative data can contribute to identify patients who could benefit from targeted interventions to prevent further fractures.

Association of functional and cognitive impairment severity with discharge to long-term care facilities in older patients admitted to a general acute care hospital from home.

BACKGROUND: The early recognition of hospitalized patients at risk of being discharged to long-term care facilities (LTCFs) may help to identify those who require transitional care programs and interventions that support discharge to home. We examined the association of functional and cognitive impairment severity with discharge to LTCFs among older hospitalized patients. METHODS: In this retrospective cohort study, we used an administrative claims database linked with geriatric assessment data from a general acute care hospital in Japan. We analyzed patients aged ≥65 years discharged between July 2016 and December 2018. The severity of functional and cognitive impairments was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) scale. Based on their DASC-8 scores, patients were designated as Category I (no impairment), Category Ⅱ (mild impairment), or Category III (moderate/severe impairment). We conducted logistic regression analyses to examine the association between the severity of impairments and discharge to LTCFs after adjusting for patient-level factors. RESULTS: We analyzed 9,060 patients (mean age: 79.4 years). Among the 112 patients (1.2%) discharged to LTCFs, 62.3%, 18.6%, and 19.2% fell under Category I, Category Ⅱ, and Category III, respectively. Category II was not significantly associated with discharge to LTCFs. However, Category III had a significantly higher odds of discharge to LTCFs than Category I (Adjusted odds ratio: 2.812, 95% confidence interval: 1.452-5.449). CONCLUSION: Patients identified as Category III by the DASC-8 on admission may benefit from enhanced transitional care and interventions that promote discharge to home.

All-Cause Readmission or Potentially Avoidable Readmission: Which Is More Predictable Using Frailty, Comorbidities, and ADL?

Background and Objectives: Readmission-related health care reforms have shifted their focus from all-cause readmissions (ACR) to potentially avoidable readmissions (PAR). However, little is known about the utility of analytic tools from administrative data in predicting PAR. This study determined whether 30-day ACR or 30-day PAR is more predictable using tools that assess frailty, comorbidities, and activities of daily living (ADL) from administrative data. Research Design and Methods: This retrospective cohort study was conducted at a large general acute care hospital in Tokyo, Japan. We analyzed patients aged ≥70 years who had been admitted to and discharged from the subject hospital between July 2016 and February 2021. Using administrative data, we assessed each patient's Hospital Frailty Risk Score, Charlson Comorbidity Index, and Barthel Index on admission. To determine the influence of each tool on readmission predictions, we constructed logistic regression models with different combinations of independent variables for predicting unplanned ACR and PAR within 30 days of discharge. Results: Among 16 313 study patients, 4.1% experienced 30-day ACR and 1.8% experienced 30-day PAR. The full model (including sex, age, annual household income, frailty, comorbidities, and ADL as independent variables) for 30-day PAR showed better discrimination (C-statistic: 0.79, 95% confidence interval: 0.77-0.82) than the full model for 30-day ACR (0.73, 0.71-0.75). The other prediction models for 30-day PAR also had consistently better discrimination than their corresponding models for 30-day ACR. Discussion and Implications: PAR is more predictable than ACR when using tools that assess frailty, comorbidities, and ADL from administrative data. Our PAR prediction model may contribute to the accurate identification of at-risk patients in clinical settings who would benefit from transitional care interventions.

Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan.

BACKGROUND: In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users. OBJECTIVE: This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs. METHODS: This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use. RESULTS: The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5%, 10.1%, 7.7%, and 7.2% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use. CONCLUSIONS: For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information.

Pet ownership-related differences in medical and long-term care costs among community-dwelling older Japanese.

This study examined the differences in medical and long-term care costs over 18 months between pet owners and non-owners among community-dwelling older Japanese. Pet ownership data were collected from 460 community-dwelling adults age 65 years and older. These data were matched with data from the National Health Insurance, health insurance for older people, and Long-Term Care Insurance beneficiaries for 17 months back from the survey on pet ownership. Pet-ownership group-specific trajectories in monthly medical and long-term care costs were modeled by a generalized estimating equation. Among pet owners (n = 96, 20.9%) and non-pet owners (n = 364, 79.1%) there were no significant differences in baseline demographic or health characteristics including chronic disease and self-reported long-term care level. At baseline, pet owners had estimated monthly medical costs of ¥48,054 (SE = 0.11; $418), compared to ¥42,260 (SE = 0.06; $367) for non-pet owners. The monthly medical costs did not differ significantly between the two groups during the 18-month follow-up period. At baseline, estimated monthly long-term care costs of pet owners and non-pet owners were ¥676 (SE = 0.75; $6) and ¥1,420 (SE = 0.52; $12), respectively. During the follow-up period, the non-pet owner to owner ratio of monthly long-term care costs was 1.2 at minimum and 2.3 at maximum. This study showed that monthly long-term care costs for pet owners were approximately half those of non-pet owners. Pet owners might use long-term care services less frequently, or use lighter care services.

The effects of dental visits on the occurrence of acute hospitalization for systemic diseases among patients aged 75 years or older: A propensity score-matched study.

BACKGROUND: Although several studies examined the association between oral status and the risk of systemic diseases, few have examined whether dental visits affect the occurrence of acute hospitalization due to systemic diseases. This study examined the effects of dental visits on preventing the occurrence of acute hospitalization due to systemic diseases in adults aged ≥ 75 years, in order to optimize the healthcare system for older adults. METHODS: This propensity-score-matched retrospective cohort study was conducted using medical insurance claims data from Hokkaido, Japan. We analyzed 432,292 adult outpatients aged ≥ 75 years between September 2016 and February 2017 (baseline period). The exposure variable was visits to the dental office during the baseline period. The primary outcome variable was the occurrence of acute hospitalization due to pneumonia, urinary tract infections, cerebrovascular diseases, or coronary heart diseases between March 2017 and March 2019. RESULTS: Among the 432,292 patients before propensity score matching, 149,639 (34.6%) had visited the dental office. One-to-one propensity score matching produced 149,289 matched pairs adjusted for the differences in all covariables (age, sex, copayment rate, annual health checkup, chronic diseases, and residential area). In these matched pairs, the risk ratio of the occurrence of acute hospitalization due to pneumonia, urinary tract infections, and cerebrovascular diseases was lower among patients who had visited dental office than among those who did not. CONCLUSIONS: Dental visits appeared to be effective in preventing acute hospitalization due to systemic diseases, thus, dental care services would be an important component of healthcare for older adults.

Effects of Early Postdischarge Rehabilitation Services on Care Needs-Level Deterioration in Older Adults With Functional Impairment: A Propensity Score-Matched Study.

OBJECTIVE: To examine the effects of early postdischarge rehabilitation on care needs-level deterioration in older Japanese patients. DESIGN: Propensity score-matched retrospective cohort study. SETTING: A secondary data analysis was conducted using medical and long-term care insurance claims data from a suburban city in Japan. PARTICIPANTS: We analyzed patients (N=2746) aged 65 years or older who were discharged from hospital to home between April 2012 and March 2014 and had care needs certification indicating functional impairment. INTERVENTIONS: The provision of early rehabilitation services by rehabilitation therapists within 1 month of discharge. Propensity score matching was used to control for differences in characteristics between patients with and without early rehabilitation services. MAIN OUTCOME MEASURES: Any deterioration in care needs level during the 12-month period after discharge. Cox proportional hazards analyses were conducted to identify the association between the exposure and outcome variables after matching. RESULTS: Among 2746 patients, 573 (20.9%) used early rehabilitation services. Care needs-level deterioration occurred in 508 patients (incidence: 18.3 per 1000 person-months), of which 76 used early rehabilitation services (12.3 per 1000 person-months) and 432 did not use early rehabilitation services (20.0 per 1000 person-months). One-to-one propensity score matching produced 566 matched pairs that adjusted for the differences in all covariables. In these matched pairs, the hazard of care needs-level deterioration was significantly lower among patients who used early rehabilitation services (hazard ratio=0.712, 95% CI, 0.529-0.958). A Kaplan-Meier survival analysis showed similar results (log-rank: P=.023). CONCLUSIONS: Early rehabilitation services provided by rehabilitation therapists after hospital discharge appeared effective in preventing care needs-level deterioration, and involving rehabilitation therapists in transitional care may aid the optimization of health care for older Japanese adults with functional impairment.

Characteristics associated with hospitalization within 30 days of geriatric intermediate care facility admission.

AIM: To identify facility-level characteristics associated with hospitalization within 30 days after admission to a geriatric intermediate care facility (GICF) (30-day hospitalization) in Japan. METHODS: This retrospective cohort study used nationwide long-term care insurance claims data and a national survey of long-term geriatric care facilities. The study population was residents admitted to GICFs between October 2016 and February 2018. The outcome variable was 30-day hospitalization. The independent variables were facility-level characteristics such as level of healthcare professionals. RESULTS: The final sample for analysis comprised 282 991 residents of mean age ± SD, 85.8 ± 7.2 years, of whom 12 814 (4.5%) experienced 30-day hospitalization. In a multivariable logistic generalized estimating equation model adjusted for facility- and resident-level characteristics, and clustering GICFs, the odds of 30-day hospitalization were 0.906 times lower (95% confidence interval [CI] 0.857-0.958) among residents in a GICF with dental hygienist than in those in a facility without. Furthermore, the risk of 30-day hospitalization was lower among residents who had been admitted to a GICF with higher staffing levels of pharmacists (adjusted odds ratio [aOR] 0.941, 95% CI 0.899-0.985), registered nurses (aOR 0.931, 95% CI 0.880-0.986), care workers (aOR 0.920, 95% CI 0.879-0.964) and speech-language pathologists (aOR 0.926, 95% CI 0.874-0.982) than in those who had been admitted to a GICF with fewer of these healthcare professionals. CONCLUSIONS: Transitional care including dental hygienist or higher staffing levels of pharmacists, registered nurses, care workers and speech-language pathologists may be a more effective way to prevent 30-day hospitalization. Geriatr Gerontol Int 2021; 21: 1010-1017.

Associations of coprescribed medications for chronic comorbid conditions in very old adults with clinical dementia: a retrospective cohort study using insurance claims data.

OBJECTIVE: To assess the association of coprescribed medications for chronic comorbid conditions with clinical dementia in older adults, as indicated by the initiation of a new prescription of antidementia medication (NPADM). DESIGN: Retrospective enumeration cohort study. SETTING: A Japanese city in Tokyo Metropolitan Area. PARTICIPANTS: A total of 42 024 adults aged ≥77 years residing in Kashiwa City, a suburban city of Tokyo Metropolitan Area, who did not have any prscription of antidementia medication from 1 April to 30 June 2012. MAIN OUTCOME MEASURE: The primary outcome was NPADM during follow-up period until 31 March 2015 (35 months). Subjects were categorised into four age groups: group 1 (77-81 years), group 2 (82-86 years), group 3 (87-91 years) and group 4 (≥92 years). In addition to age and sex, 14 sets of medications prescribed during the initial background period (from 1 April 2012 and 31 June 2012) were used as covariates in a Cox proportional hazard model. RESULTS: In a follow-up period of 1 345 457 person-months (mean=32.0±7.5 months, median 35 months), NPADM occurred in 2365 subjects. NPADM incidence at 12 months was 1.9%±0.1% (group 1: 0.9%±0.1%, group 2: 2.1%±0.1%, group 3: 3.2%±0.2% and group 4: 3.6%±0.3%; p<0.0001). In addition to older age and female sex, use of the following medications was significantly associated with NPADM: statins (HR: 0.82, 95% CI 0.73 to 0.92; p=0.001), antihypertensives (HR: 0.80, 95% CI 0.71 to 0.85; p<0.0001), non-steroidal bronchodilators (HR: 0.72, 95% CI 0.58 to 0.88; p=0.002), antidepressants (HR: 1.79, 95% CI 1.47 to 2.18; p<0.0001), poststroke medications (HR: 1.45, 95% CI 1.16 to 1.82; p=0.002), insulin (HR: 1.34, 95% CI 1.01 to 1.78; p=0.046) and antineoplastics (HR: 1.12, 95% CI 1.01 to 1.24; p=0.035). CONCLUSIONS: This retrospective cohort study identified the associations of coprescribed medications for chronic comorbid conditions with NPADM in older adults. These findings would be helpful in understanding the current clinical practice for dementia in real-world setting and potentially contribute to healthcare policymaking. TRIAL REGISTRATION NUMBER: UMIN000039040.

Association of cognitive impairment severity with potentially avoidable readmissions: A retrospective cohort study of 8897 older patients.

INTRODUCTION: Understanding the association between cognitive impairment severity and potentially avoidable readmissions (PARs) in older patients may facilitate the identification of at-risk individuals who would benefit from readmission prevention measures. METHODS: This retrospective cohort study was conducted using claims data linked with routinely collected cognitive impairment assessment results from a general acute care hospital in Tokyo, Japan. Patients were 65 years or age or older who were discharged from the subject hospital to home or a facility between July 2016 and September 2018. RESULTS: A multivariable logistic regression analysis adjusted for covariates showed that the odds of PARs within 90 days to the subject hospital for patients with moderate and severe cognitive impairment were 1.418 times (95% confidence interval: 1.005-2.002) and 2.212 times (95% confidence interval: 1.206-4.058) higher, respectively, that for patients with normal cognition. DISCUSSION: Older inpatients with later-stage cognitive impairment may represent a suitable target population for transitional care programs aimed at reducing readmissions.

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan.

OBJECTIVE: To examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults. METHODS: Postal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model). RESULTS: Almost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303-0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338-3.470). DISCUSSION: Older adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.

[Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching].

Objectives　To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults.Methods　Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1 : 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model).Results　The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio=0.51, 95% confidence interval [CI]=0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio=0.36, 95%CI=0.11-1.21, P=0.099; LTC cost per unit follow-up period: cost ratio=0.36, 95%CI=0.11-1.12, P=0.076).Conclusions　These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.