2019 Volume 31 Issue 1 Pages 15-23
Object: To clarify the actual condition of long-term care requirements in elderly patients with rheumatoid arthritis（RA）and to examine the factors contributing to the need for care.
Method: We surveyed long-term care certification status of 712 elderly RA patients （age > 65 years）who were outpatients at our hospital and are in the Japanese long-term care insurance system. The patients were classified as（A）certified as requiring long-term care 1–5,（B）requiring support afforded by long-term care certification, and（C）not certified. These groups were examined by comparing data on parameters such as the duration of disease and Disease Activity Score（DAS）28, Japanese Health Assessment Questionnaire（JHAQ）, and treatment details.
Results: The numbers of patients in groups A, B, and C were 103, 80, and 525, respectively, and ４ patients were excluded as their certification status was unknown. Accreditation rate of group A and B, 26.3%, was higher than the general elderly population. JHAQ was the most contributing variable that predicted the need for long-term care（OR: 5.00, 95% Confidence Interval: 3.24 - 7.97）during multivariate logistic analysis using age, gender, medication, and composite measures as independent variables. ROC curve analysis of JHAQ as an independent variable for long-term care certification yielded a cutoff value of 0.75, AUC of 0.88, sensitivity of 84.2%, and specificity of 79.6%.
Conclusion: Patients with RA tended to have a greater need for long-term care than the general population. JHAQ makes the greatest contribution to assess the need for caregiving, and the degree of care needed can be estimated from its score. Therefore, measures for reduction of JHAQ scores of RA patients to less than 0.75 and prevention of complications can reduce the need for long-term care of patients.
