BACKGROUND AND OBJECTIVES

With the global population aging, there is an emerging need for access to quality longterm care (LTC) services. Many countries have developed LTC systems while others are at the infancy stage. This paper aimed to provide an overview of the country’s readiness for LTC based on the perspectives of relevant stakeholders. Specifically, it described the roles, initiatives, and challenges of relevant organizations and community leaders for LTC provision. It also described the older persons (OPs) and carers’ perspectives towards LTC including their awareness, capacity, and preferences.

The study utilized a descriptive design using qualitative methods of data collection namely key informant interviews (KIIs) and focus group discussions (FGDs). Participating institutions and their designated representatives were purposively sampled as key informants. OPs and carers from select barangays in NCR and Region IVA participated in the FGDs. Guided by the interpretivism approach, thematic analysis was performed. A trained research assistant coded the FGD and KII transcripts through the Nvivo PRO plus software and verified by the first author. Themes were reviewed and validated by the multidisciplinary team.

A total of 15 KIIs and two FGDs were conducted. The participating institutions and organizations were found to have varied roles and initiatives relevant to LTC; from strategic planning, development of policies and standards of care, training and capacity-building, and up to the actual implementation of LTC services. Identified challenges include implementation issues, financial issues, lack of political and stakeholder support, OPs and familial issues, and lack of knowledge on LTC.

Participants shared their description on what LTC is, an LTC facility, and the conditions of those in LTC facility. OPs expressed their willingness to utilize LTC services and identified several factors related to their preferred LTC arrangements. Carers identified various topics related to taking care of OPs that they would like to learn.

The roles, initiatives, and awareness of relevant stakeholders, older persons, and carers towards LTC were found to greatly vary. Policy makers, health workforce, families, communities, and the older persons themselves should have a better understanding of longterm care before they can provide or utilize the system. With the current landscape of LTC provision, the country still has a long way to go in achieving the integrated continuum of LTC appropriate to promote healthy aging. Promoting awareness, integrating LTC in the current programs and services for older persons in the country, capacitating the formal and non-formal caregivers, and strengthening collaborations are recommended.

Further research on quantitative measures of readiness for long-term care with focus on the health system and in-depth studies on the varieties or models of long-term care are recommended.

Background and Objectives With the global population aging, there is an emerging need for access to quality longterm care (LTC) services. Many countries have developed LTC systems while others are at the infancy stage. This paper aimed to provide an overview of the country’s readiness for LTC based on the perspectives of relevant stakeholders. Specifically, it described the roles, initiatives, and challenges of relevant organizations and community leaders for LTC provision. It also described the older persons (OPs) and carers’ perspectives towards LTC including their awareness, capacity, and preferences.
Home Care Services ; Long-Term Care ; Nursing Homes ; Philippines

BACKGROUND: Individual-level social capital is an important determinant of older adults' long-term care needs; however, there is scant evidence regarding community-level social capital. Therefore, we investigated the association between community-level social capital and the prevalence of the need for long-term care among older adults. METHODS: Between January and February 2018, a cross-sectional survey was conducted among all older adults (n = 13,558) aged 65 to 74 years in a rural municipality in Japan (total population, n = 72,833). A self-reported questionnaire was used to identify community-level social capital, comprising civic participation, social cohesion, and reciprocity. A multilevel logistic regression analysis was performed to estimate the odds ratios of the need for long-term care and a decline in social activity competence as assessed by instrumental activities of daily living. For the analysis, the community levels were divided into 76 voting districts and adjusted for daily life, lifestyle, socioeconomic status, health conditions, and the three social capital subscale scores at the individual level. RESULTS: After adjusting for the covariates, we observed a tendency that a higher community level of reciprocity was associated with a lower prevalence of long-term care needs (OR: 0.86, 95% confidence interval: 0.75-1.00), whereas a high community level of social cohesion was associated with a significantly reduced decline in instrumental activities of daily living (OR per standard deviation increase: 0.87, 95% confidence interval: 0.79-0.96). No significant association was found with civic participation. Similarly, individual-level social capital was associated with the need for long-term care and decline in instrumental activities of daily living. CONCLUSIONS Our findings suggest that good community-level reciprocity or social cohesion as well as good individual social capital status may help prevent the need for long-term care among older adults.
Humans ; Aged ; Interpersonal Relations ; Activities of Daily Living ; Social Participation ; Social Capital ; Multilevel Analysis ; Cross-Sectional Studies ; Long-Term Care ; Japan/epidemiology* ; Social Support

BACKGROUND: The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study was launched to investigate risk factors for osteoporotic fractures, interactions of osteoporosis with other non-communicable chronic diseases, and effects of fracture on QOL and mortality. METHODS: FORMEN baseline study participants (in 2007 and 2008) included 2012 community-dwelling men (aged 65-93 years) in Nara prefecture, Japan. Clinical follow-up surveys were conducted 5 and 10 years after the baseline survey, and 1539 and 906 men completed them, respectively. Supplemental mail, telephone, and visit surveys were conducted with non-participants to obtain outcome information. Survival and fracture outcomes were determined for 2006 men, with 566 deaths identified and 1233 men remaining in the cohort at 10-year follow-up. COMMENTS The baseline survey covered a wide range of bone health-related indices including bone mineral density, trabecular microarchitecture assessment, vertebral imaging for detecting vertebral fractures, and biochemical markers of bone turnover, as well as comprehensive geriatric assessment items. Follow-up surveys were conducted to obtain outcomes including osteoporotic fracture, cardiovascular diseases, initiation of long-term care, and mortality. A complete list of publications relating to the FORMEN study can be found at https://www.med.kindai.ac.jp/pubheal/FORMEN/Publications.html .
Aged ; Bone Density ; Cardiovascular Diseases/etiology* ; Cohort Studies ; Geriatric Assessment ; Humans ; Independent Living ; Japan/epidemiology* ; Long-Term Care/statistics & numerical data* ; Male ; Middle Aged ; Osteoporosis/etiology* ; Osteoporotic Fractures/etiology* ; Risk Factors

BACKGROUND: The July 2018 Japan Floods caused enormous damage to western Japan. Such disasters can especially impact elderly persons. Research has shown that natural disasters exacerbated a decline in cognitive function, but to date, there have been no studies examining the effects of this disaster on the elderly. The object of this study was to reveal the effect of this disaster in terms of cognitive decline among the elderly. METHODS: Study participants were certified users of the long-term care insurance (LTCI) system in Hiroshima, Okayama, and Ehime prefectures from May 2018 to June 2018. The observation period was from July 2018 to December 2018. Our primary outcome was cognitive decline after the disaster using a dementia symptomatology assessment. In addition to a crude model, a multivariate Cox proportional hazards model was used to assess the cognitive decline of victims, adjusting for age classification, gender, the level of dementia scale before the disaster occurred, residential environment, whether a participant used facilities shut down after the disaster, and population density. After we confirmed that the interaction term between victims and residential environment was statistically significant, we stratified them for the analysis. RESULTS: The total number of participants was 264,614. Victims accounted for 1.10% of the total participants (n = 2,908). For the Cox proportional hazards model, the hazard ratio of the victims was 1.18 (95% confidential interval (CI): 1.05-1.32) in the crude model and 1.12 (95% CI: 1.00-1.26) in the adjusted model. After being stratified by residential environment, the hazard ratio of home victims was 1.20 (95% CI: 1.06-1.36) and the hazard ratio of facility victims was 0.89 (95% CI: 0.67-1.17). CONCLUSIONS This study showed that elderly living at home during the 2018 Japan Floods were at risk for cognitive decline. Medical providers, care providers, and local governments should establish a system to check on the cognitive function of elderly victims and provide necessary care support.
Aged ; Cognitive Dysfunction/etiology* ; Floods ; Humans ; Insurance, Long-Term Care ; Japan/epidemiology* ; Retrospective Studies

Background: Patient-centered outcomes in chronic care assessed through Quality of Health Care can be measured by its congruence to the Chronic Care Model (CCM) using Patient Assessment of Chronic Illness Care (PACIC). Behavioral and quality measures that influence the patient’s perception of the quality of care remain unknown. Objective: This study aimed to assess the quality of chronic illness care among diabetic patients using PACIC and its relationship to socio-demographic factors. Methods: A cross-sectional study involving diabetic patients of the Out-Patient Department of a private hospital were enrolled through non-probability sampling. Overall score from the PACIC questionnaire, its subscale scores and its relationship with the socio-demographic factors were determined using descriptive statistics. Results: All participants were married and living with their families. Median age was 58. The over- all PACIC score was 3.53 + 0.72 SD. Problem solving/Contextual subscale presented the highest score while follow up/coordination had the least. Those who have college degrees had significantly lower mean scores than high school graduates (p-value = 0.032). Conclusion PACIC scores indicate a moderate to high quality of care. PACIC is a practical instrument that can be used in quality assessment and improvement programs.
Outpatients ; Diabetes Mellitus ; Chronic Disease ; Long-Term Care ; Hospitals, Private

BACKGROUND: Preventing the need for long-term care (LTC) by identifying physical function risk factors are important to decrease the LTC burden. The objective of this study was to investigate whether grip strength and/or walking speed, which are components of the frailty definition, are associated with LTC in community-dwelling older and oldest people. METHODS: The participants were 1098 community-dwelling older and oldest people who had not received LTC at the baseline. The endpoint was receiving LTC after the baseline survey. The independent variables were grip strength and walking speed, and participants were divided into two groups based on these variables. The confounding factors were age, sex, the Japanese version of the Montreal Cognitive Assessment (MoCA-J), hypertension, diabetes mellitus, stroke, joint diseases, living alone, body mass index, and serum albumin. We calculated the hazard ratio of receiving LTC using the Cox proportional hazard model. RESULTS: Among the 1098 participants, 107 (9.7%) newly received LTC during the follow-up. Regarding the physical function, only slow walking speed was significantly correlated with LTC after adjusting for all confounding factors except the MoCA-J score (HR = 1.74, 95% CI = 1.10-2.75, P = .018). However, slow walking speed was still a risk factor for LTC after adjusting for the MoCA-J score and other confounding factors (HR = 1.64, 95% CI = 1.03-2.60, P = .037). CONCLUSIONS The findings from this study may contribute to a better understanding of slow walking speed as a factor related to LTC, which might be a criterion for disability prevention and could serve as an outcome measure for physical function in older people.
Aged ; Aged, 80 and over ; Exercise ; Female ; Humans ; Independent Living ; statistics & numerical data ; Japan ; Long-Term Care ; statistics & numerical data ; Male ; Proportional Hazards Models

Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results.RESULTS: The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001).CONCLUSION: The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.]]>
Activities of Daily Living ; Adult ; Cohort Studies ; Follow-Up Studies ; Gait ; Geriatric Assessment ; Humans ; Insurance, Long-Term Care ; Long-Term Care ; Mass Screening ; National Health Programs

BACKGROUND/OBJECTIVES: This study investigated nutritional status of the elderly with dementia in a care facility with the aim of improving the meal quality of the facility. SUBJECTS/METHODS: Data were collected from 30 dementia patients aged more than 65 years in a long-term care facility in Hongseong. The data were obtained from questionnaires and medical records. The food intake data was obtained using food photographs and the nutrient intakes were calculated using the CAN-Pro 5.0. The data were compared with the dietary reference intakes for Koreans (KDRIs). The nutrient density, diet quality such as nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ), as well as dietary diversity score (DDS) were evaluated. The data were analyzed using SPSS statistical programs. RESULTS: The average daily energy intakes for men and women were much lower than the estimated energy requirements of the KDRIs. The average intakes of energy and most nutrients in the general diet group were significantly higher than those of the other two groups. Significant differences in diet quality and diet diversity were observed according to the meal type groups. The NARs of some minerals (calcium, iron, and zinc) and vitamins (vitamin B6 and folic acid) were less than 0.5 in all study groups. The NARs of protein, iron and MAR of the general diet group were significantly higher than those of the liquid diet group. The DDS scores of meats, fruits and diary food group were very low in all meal type groups, meaning that the diet qualities of the study subjects were not appropriate in all meal type groups. CONCLUSIONS: The food intakes of the study groups showed some limitations by a direct comparison with KDRIs because of the very low physical activities of the study subjects. The diet quality and diet diversity indices suggest the need for improvements in the nutritional quality in all types of diet. Overall, new intervention strategies targeting facility residents with dementia in Korea are needed as soon as possible.
Aged ; Dementia ; Diet ; Eating ; Female ; Fruit ; Humans ; Iron ; Korea ; Long-Term Care ; Male ; Meals ; Meat ; Medical Records ; Minerals ; Miners ; Motor Activity ; Nutrition Assessment ; Nutritional Status ; Nutritive Value ; Recommended Dietary Allowances ; Vitamins

PURPOSE: This study aimed to assess hand hygiene (HH) compliance among visitors at a long-term care hospital in South Korea. METHODS: The study was conducted at a 502-bed long-term care hospital located in Gyeonggi-do Province. From July 1 to August 15, 2017, including more than 6 weekends and one holiday, a trained observer covertly assessed visitors' HH at all five units (360 beds in total) of the study hospital building until the completion of 1,000 HH opportunities (i.e., 200 opportunities per unit). The modified World Health Organization (WHO) HH observation form was used. Instead of professional categories and the “before clean/aseptic procedure” moment, the estimated age range for each visitor were recorded in four categories: children (<14 years old), adolescents (14~18), adults (19~64), and the elderly (≥65). The collected data were analyzed using SPSS 22.0. RESULTS: A total of 1,000 HH opportunities were observed from 766 visitors (an average of 1.31 per visitor) and the overall HH compliance rate was 20.3%. Overall, 53.7% of the HH cases were performed with soap and water. Among the 4 HH moments, the “after body fluid exposure risk” moment showed the highest compliance rate (83.5%); 93.9% used soap and water. The most commonly exposed potential body fluid among visitors was saliva (48.1%). CONCLUSION: For hospital visitors in long-term care hospitals, HH education programs including HH moments need to be developed and implemented. Further studies are necessary to evaluate visitors' HH compliance in various hospital settings and find the related variables influencing visitors' HH.
Adolescent ; Adult ; Aged ; Body Fluids ; Child ; Compliance ; Education ; Gyeonggi-do ; Hand Hygiene ; Hand ; Holidays ; Humans ; Korea ; Long-Term Care ; Observational Study ; Saliva ; Soaps ; Visitors to Patients ; Water ; World Health Organization