居家护理服务使用与日本老年人护理需求水平变化的关系。
Relationship between home care service use and changes in the care needs level of Japanese elderly.
机构信息
Department of Health Services Research, Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
出版信息
BMC Geriatr. 2009 Dec 21;9:58. doi: 10.1186/1471-2318-9-58.
BACKGROUND
With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.
METHODS
The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.
RESULTS
In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.
CONCLUSION
There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.
背景
随着日本长期护理保险（LTCI）的引入，为社区居住的老年人提供了更多的家庭护理服务。为了提供有效的家庭护理服务，了解服务使用的效果很重要。在这项研究中，作为确定这一点的第一步，我们试图描述在护理需求水平不同的持续/改善组和恶化组中，不同的家庭服务使用情况，并报告家庭护理服务使用与护理需求水平变化之间的关系。
方法
参与者包括日本一个城市的 1474 名 LTCI 服务使用者中的 624 名。根据基线护理需求水平，家庭护理服务使用者分为“较低护理需求水平亚组”和“较高护理需求水平亚组”。对简单的统计比较和将护理需求水平的变化作为因变量的多元逻辑回归分析进行了分析。性别、年龄和基线护理需求水平被指定为控制变量。家庭服务被视为自变量。在这项研究中，家庭护理服务包括家庭帮助、家庭沐浴服务、访问护士、家庭康复、疗养院日托、健康日托、医疗设备贷款、疗养院临时住宿、疗养院临时住宿、疗养院式医疗设施临时住宿和医生的医疗管理。
结果
在较低护理需求水平亚组中，年龄（OR=1.04，CI，1.01-1.08）、使用疗养院临时住宿（OR=2.55；CI，1.43-4.56）和在 11 个月期间使用的长期护理服务类型数（OR=1.33；CI，1.02-1.74）与使用者护理需求水平的恶化显著相关。在较高护理需求水平亚组中，使用医生的医疗管理（OR=6.99；CI，1.42-41.25）与使用者护理需求水平的恶化显著相关。没有与维持或改善使用者护理需求水平显著相关的家庭服务。
结论
两组（持续/改善组和恶化组）的家庭服务使用情况不同。在日本，较低护理需求水平的社区居住老年人中，疗养院临时住宿服务的使用和更多类型的服务使用与护理需求水平的恶化有关。此外，医生的医疗管理服务与较高护理需求水平的社区居住老年人护理需求水平的恶化有关。
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