Abstract
PURPOSE The purpose of this study was to follow up survival and changes in the level of care needed for elderly patients 2 years (730 days) after recognition of their need for care in the public nursing-care insurance scheme, and to clarify the factors determining their prognosis in order to draw up intervention measures.
METHODS A total of 2,386 patients aged over 65 years (702 men and 1,684 women) who were recognized as in need of care between 21st October 1999 and 27th April 2000 were followed up with a multivariate logistic regression analysis. The dependent variable was life/death during the 2 years after recognition, and independent variables were sex, age, present address, the initial level of care needed, and care-requiring disorders. The same analysis was also applied to the 1,549 (440 men and 1,109 women) who were still alive 2 years after recognition. The dependent variable was whether the level of care had deteriorated, and independent variables were the same as previously employed.
RESULTS When the odds ratio of survival was set at 1.0 for the male patients aged over 65 years, that for the females was 1.995. When the odds ratio was set at 1.0 for the patients aged 65-69 years, that for those aged 85 years and over was 0.593. When the odds ratio was set at 1.0 for the patients in need of long-term support, that for those in level 2 was 0.458, that in level 3 was 0.326, that in level 4 was 0.257, and that in level 5 was 0.154, respectively. There were no significant differences in the odds ratios among the care-requiring disorders and present addresses.
When the odds ratio for deterioration in the level of care was set at 1.0 for the patients aged 65-69 years who survived 2 years afer recognition, that for those aged 80-84 years was 1.820, and that for those aged 85 years and over was 1.983. When the odds ratio was set at 1.0 for the patients with Alzheimer's disease, the values were 0.482 for dementia of unknown etiology, 0.110 for subarachnoid hemorrhage, 0.415 for cerebral hemorrhage, 0.431 for cerebral infarction, 0.240 for musculoskeletal diseases, and 0.359 for miscellaneous diseases. There were no significant differences in the odds ratios between sexes, among the initial levels of care, and among present addresses.
CONCLUSION The present 2 year cohort study of odds ratios of survival and deterioration in the level of care for the patients aged over 65 years revealed the survival of female patients to be twice that for males. The odds ratio of deterioration was higher for the patients aged 80-84 years and 85 years and over than those aged 65-69 years. The higher the initial level of care, the lower the survival odds ratio. The odds ratio of survival was lower for those aged 85 years and over than for those aged 65-69 years. These results indicate that the numbers of the elderly long-term care patients do not increase at the same rate as the numbers of the elderly. The odds ratio of deterioration was lower for patients with all diseases except vascular dementia than those with Alzheimer's disease. If reduction of the odds ratio of deterioration for the patients with all diseases except Alzheimer's disease and vascular dementia can be achieved by provision of sufficient services covered by public nursing-care insurance, such an approach should be stressed to prevent increase in the needs for long-term nursing-care.
