Objective The aim of this nationwide study was to estimate the duration of formal long-term care, provided by Japanese long-term care insurance (LTCI) services, among frail Japanese elderly people living in the community.
Methods The study subjects were 2,188,397 (men: 579,422, women: 1,124,022, age≥65 years) beneficiaries who used LTCI services for community living in June 2013. The duration of LTCI services for community living per diem per capita was estimated by converting the benefit amount to duration of care using the code for service in claims bills according to gender and care levels, which are a nationally certified classification of individual needs for long-term care (care level 1: lowest need, care level 5: highest need). Subsequently, LTCI services for community living were categorized into respite services and community services. Community services were further subcategorized into home visiting services and daycare services.
Results The overall average duration of formal care per diem per capita for men and women were 97.4 and 112.7 minutes for care level 1, 118.3 and 149.1 for care level 2, 186.9 and 246.4 for care level 3, 215.2 and 273.2 for care level 4, and 213.1 and 261.4 for care level 5, respectively. Length of respite services increased gradually with care level, whereas duration of community services peaked at care level 3 and decreased at care levels 4 and 5. With regard to the community service subcategories, duration of home visiting services increased with care level, but duration of daycare services peaked at care level 3.
Conclusion Although the care levels in the LCTI system are designed to assess the need for formal care in terms of duration of care, our results suggest that the use of formal LTCI services for community living is not vertically equitable. Services that efficiently increase duration of formal care for those with higher needs for care may improve the equity and sustainability of formal long-term care services for community living.
Objectives The goal of this study was to determine whether experiencing Japan's specific medical checkup is associated with a health promotion lifestyle, health literacy (HL), and social capital (SC) by type of healthcare coverage.
Methods The subjects were 1,048 residents of A City aged 40 through 74 years. Individuals who had experienced more than one medical checkup during the past two years were categorized as “Consultation.” Individuals without that experience were categorized as “No consultation.” Data were collected via an anonymous self-administered mail questionnaire survey. Health promotion lifestyles were assessed using a Japanese version of the Health-Promoting Lifestyle Profile (HPLP II). HL was measured with the 14-item Health Literacy Scale. The SC was measured following Hanibuchi's six-item scale.
Results The response rates were 34.4% for males and 39.6% for females. Of the males covered by National Health Insurance (NHI), 68.8% were Consultation. Of the females covered by NHI, 79.4% were Consultation. Of the males covered by social insurance, 91.7% were Consultation, and 72.6% of the females covered by social insurance were Consultation. The consultation ratio of males covered by NHI was significantly lower among those without a co-residential spouse than among those living with a spouse. The physical activity score (a HPLP II subscale) of the females covered by NHI was significantly lower among those without compared to those with consultation. Among the males covered by social insurance, the nutrition score (a HPLP II subscale) was significantly higher among those without compared to those with consultation, and the number of neighbors providing companionship (an item in the SC scale) was larger. Among the females covered by social insurance, the health responsibility score (a HPLP II subscale) was significantly lower among those without than among those with consultation.
Conclusion There were significant relationships between experiencing more than one medical checkup during the past two years and health promotion lifestyles and between that experience and social capital, except for males covered by NHI. Policies based on these results are encouraged to increase participation in medical checkups. Regarding males covered by NHI, support of their participation in medical checkups by people close to them would be an effective way to increase participation.
Objective The goal of the study was to assess the relationships of the frequency (more than one time per week) of various activities to frailty among independent elderly people in Japan.
Methods Survey data were collected from 73,341 community-dwelling elders who were not certified as Needing Long-Term Care. Basic checklist survey items developed by the Ministry of Health, Labour and Welfare were used along with exhaustive items on the weekly physical, cultural, community, and volunteer activities of the respondents. The effects of the frequencies of each activity with and without frailty were estimated. The relationship between frailty and pre-frailty was analyzed in a multinomial logistic regression model regarding involvement in activities and controlling for the effects of gender, age, and with non-frailty as a reference category.
Results Data on 49,238 individuals in the study area not certified as Needing Long-Term Care (24,632 males and 24,606 females), corresponding to 67% of all elderly (aged 65 or more years) Japanese people were analyzed. About 65.9% of the respondents reported that they engaged in physical activities, 78.8% reported cultural activities, and 14.9% reported community social activities. The percentages classified as frail and pre-frail were 12.8% and 22.7%, respectively. All of the activities significantly related to frailty. The adjusted odds ratio (95% CI) of frailty among the respondents that engaged in all the types of activity was: 2.19 (1.71, 2.80) among those that reported no physical activities, 1.48 (0.91, 2.43) among those with no cultural activities, and 2.09 (1.80, 2.44) among those with no community social activities. The adjusted odds ratio on frailty for the three groups reporting one type of activity ranged from 5.40 to 6.42, which was statistically significant, and the adjusted odds ratio on the group reporting no activities was 16.41 (14.02, 19.21). These results indicate that the extent of frailty increased as the number of activities decreased.
Conclusions This cross-sectional study found that frailty among elders in Japan was separately associated with participation in cultural activities, social community activities, and physical activities. Frailty was more severe among those with less participation. This result suggests that, for elders who find it difficult to participate in physical activities, engaging in cultural or community social activities might help to prevent or delay frailty.
Objectives The importance of social capital in promoting interprofessional collaborations is well known. This study examined the effects of an interprofessional educational program for homecare professionals on building social capital in terms of homecare in an urban area.
Methods The program was conducted at Kita Ward, Tokyo, from July 2014 to January 2015. We used a self-administered questionnaire before and after the program to collect data from homecare professionals in the ward, as well as from those who were interested in providing homecare. Physicians attended a five-day program, while other professionals attended a four-and-a-half-day program. Participants' attitude toward homecare practices was assessed to evaluate their motivation level for the job (i.e., the formation of a practical view of homecare and efficacy to engage in homecare practices). Regarding social capital, we assessed trust and norm of reciprocity for those in the same profession as the respondent (bonding and cognitive social capital) as well as for those in a different profession (bridging and cognitive social capital). Additionally, to professionals other than physicians, we asked about trust and norm of reciprocity regarding physicians (bridging and cognitive social capital) and collaborative conditions with physicians, which included the two sub-domains of cooperation and interaction (bridging and structural social capital). A generalized estimating equation was used to detect the effect size.
Results Of the 54 program participants, 52 (including two physicians) completed both the pre- and post-program questionnaires. Participants' practical view of homecare was formed after the program, although their efficacy for homecare practices was unchanged. With regard to social capital, scores for both trust and norm of reciprocity for the same profession (bonding and cognitive social capital) increased, while those for different professions (bridging and cognitive social capital) were unchanged. Scores for both trust and norm of reciprocity regarding physicians and cooperation with physicians (bridging and cognitive social capital, and bridging and structural social capital) also increased. Finally, trust and norm of reciprocity for the participants improved after the program.
Conclusion The interprofessional educational program for homecare professionals may foster social capital among the participants. The study results imply that this program can be a possible strategy to foster social capital in the field of homecare.