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

Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national 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: This study investigates the impact of weekend admission with a patient safety indicator (PSI) on 30-day mortality among long-term insurance beneficiaries. METHODS: Data were obtained from the National Health Insurance Service-Senior claim database from 2002 to 2013. To obtain unbiased estimates of odds ratio, we used a nested case-control study design. The cases were individuals who had a 30-day mortality event after their last medical utilization, while controls were selected by incidence density sampling based on age and sex. We examined the interaction between the main independent variables of weekend admission and PSI by categorizing cases into four groups: weekend admission/PSI, weekend admission/non-PSI, weekday admission/PSI, and weekday admission/non-PSI. RESULTS: Of the 83,400 individuals in the database, there were 20,854 cases (25.0%) and 62,546 controls (75.0%). After adjusting for socioeconomic, health status, seasonality, and hospital-level factors, the odds ratios (ORs) of 30-day mortality for weekend admission/PSI (OR, 1.484; 95% confidence interval [CI], 1.371–1.606) and weekday admission/PSI (OR, 1.357; 95% CI, 1.298–1.419) were greater than for patients with weekday admission/non-PSI. CONCLUSION: This study indicated that there is an increased risk of mortality after weekend admission among patients with PSI as compared with patients admitted during the weekday without a PSI. Therefore, our findings suggest that recognizing these different patterns is important to identify at-risk diagnosis to minimize the excess mortality associated with weekend admission in those with PSI.
Case-Control Studies ; Diagnosis ; Humans ; Incidence ; Insurance Benefits ; Insurance, Long-Term Care ; Long-Term Care ; Mortality ; National Health Programs ; Odds Ratio ; Patient Safety ; Seasons

BACKGROUND: The food and food service influence the quality of life and the general health condition of older persons living in long-term care (LTC) facilities. Purchasing good food materials is a ground of good food service. In Korea, the residents in LTC facilities should pay for the cost of food materials and ingredients out of their pocket because it is not covered by LTC insurance. This study explored what factors affect the cost of food materials paid by LTC facility residents and which factor affects most. METHODS: We used data from the study on out-of-pocket payment on national LTC insurance, which surveyed 1,552 family caregivers of older residents in LTC facilities. We applied conditional multi-level model, of which the first level represents the characteristics of care receivers and caregivers and its second level reflects those of LTC facilities. RESULTS: We found that the facility residents with college-graduated family caregivers paid 11,545 Korean won more than those with less than elementary-graduated ones. However, the income level of family caregivers did not significantly affect the amount of the food material cost of the residents. The residents in privately owned, large, metropolitan-located facilities were likely to pay more than those in other types of facilities. The amount of the food material cost of the residents was mainly decided by the facility level factors rather than the characteristics of care recipients and their family caregivers (intra-class correlation=82%). CONCLUSION: These findings suggest that it might be effective to design a policy targeting facilities rather than residents in order to manage the cost of food materials of residents in LTC facilities. Setting a standard price for food materials in LTC facilities, like Japan, could be suggested as a feasible policy option. It needs to inform the choice of LTC users by providing comparable food material cost information. The staffing requirement of nutritionist also needs to be reviewed.
Caregivers ; Food Services ; Health Expenditures ; Humans ; Insurance ; Insurance, Long-Term Care ; Japan ; Korea ; Long-Term Care ; Nutritionists ; Quality of Life

PURPOSE: This study was conducted to investigate effects of welfare center's cognitive improvement program on the community elderly provided by nursing student volunteers and social welfare.METHODS: A quasi-experimental with non-equivalent control group pretest-posttest design was implemented. The participants were the community elderly with or without mild cognitive impairments (experimental group: 17, control group: 15). The experimental group participated in the cognitive improvement program for four months based on the demonstration program of the special grade of dementia in long-term care insurance for the elderly.RESULTS: After the intervention, the satisfaction with perceived social support (F=9.30, p=.005) was improved statistically between the experimental group and the control group, but there was no significant difference in MMSE-K, IADL, depression, EQ-VAS, and EQ-5D variables.CONCLUSION: These results indicated that a multidisciplinary approach or a variety of manpower is needed, in order to prevent the dementia of the elderly. However, in order to provide a systematic cognitive-based intervention, it was once again recognized that the training of relevant experts and the quality planning on them were very important.
Aged ; Cognitive Therapy ; Dementia ; Depression ; Humans ; Insurance, Long-Term Care ; Mild Cognitive Impairment ; Nursing ; Social Welfare ; Students, Nursing ; Volunteers

In accordance with the aged society, oral health care for the elderly is considered important to maintain general health. Although the role of dental hygienists is essential for proper health management of the oral cavity, research on the care system for the elderly people's oral health and on the role of dental hygienists in the field of elderly welfare is still insufficient. Hence, the aim of this study is to investigate the status of Korean elderly welfare system and dental hygienists by comparing them with those in Japan, a precedent of aged society. First, we compared and investigated the Japanese long-term insurance system, which provides an institutional basis for a long-term care system for the elderly in Korea. Second, the elderly welfare law and care system, focusing on oral care, were examined. Lastly, in elderly care, we analyzed the distinctions between Korea and Japan regarding dental hygienists' role and scope of work. Taken together, as a precedent of aged society, Japan has shown well-specialized and systematic welfare for the elderly compared with Korea. With the development of the welfare system for the elderly in Japan, the role and the workscope of dental hygienists have been expanded to improve quality of life of elderly people, as a key professional for elderly oral care. Therefore, we should perceive the need for improvement of long-term care insurance and the expansion of dental hygienists' work in Korea. In conclusion, these results could be used as basic data for improving the elderly welfare system and developing dental hygienists in Korea.
Aged* ; Asian Continental Ancestry Group ; Dental Hygienists* ; Humans ; Insurance ; Insurance, Long-Term Care ; Japan* ; Jurisprudence ; Korea* ; Long-Term Care ; Mouth ; Oral Health ; Quality of Life

The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.
Aged ; Community Health Centers ; Community Health Services ; Cooperative Behavior ; Delivery of Health Care ; Group Practice ; Health Services for the Aged ; Home Care Services ; Hospitals, Community ; Humans ; Insurance, Health ; Insurance, Long-Term Care ; Nutritionists ; Patient Discharge ; Private Practice ; Social Change ; Social Welfare ; Social Work ; Social Workers

OBJECTIVES: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. METHODS: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ○○. For analysis, semi-structured questionnaires that required about 20–30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. RESULTS: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. CONCLUSIONS: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.
Aged ; Cross-Sectional Studies ; Dental Hygienists ; Humans ; Insurance, Long-Term Care ; Long-Term Care ; Oral Hygiene

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.
Aged ; Aging ; Asian Continental Ancestry Group ; Exercise ; Humans ; Insurance, Long-Term Care ; Japan ; Locomotion ; Long-Term Care

PURPOSE: This study tried to identify changes in family burden after the introduction of the long-term care insurance and to examine the factors influencing subjective and objective caring burden and depression of family caregivers of elders receiving home-based long-term care. METHODS: Data were collected from 203 family caregivers of elders from August 1 to 31, 2015 using questionnaires. They were analyzed in descriptive statistics, t test, ANOVA test, and multiple regression analysis. RESULTS: The mean score of depression was 7.24, which suggested mild depression level. The subjective family burden was 2.71 and the objective burden 3.04. The factors affecting depression included subjective burden (t=5.08, p < .001), objective burden (t=2.80, p=.006), time of elderly care per day (t=−3.61, p < .001), caregiving duration (t=3.33, p=.001), age (t=3.13, p=.002), family relationship (t=2.48, p=.014), and economic status (t=1.99, p=.047). CONCLUSION: The family burden was most important influencing factor on caregiver's depression. Therefore, services and supports to alleviate caregivers' burden in the home-based care should be added to long-term care.
Aged ; Caregivers ; Depression ; Family Relations ; Humans ; Insurance, Long-Term Care ; Long-Term Care