Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai Tsukuba, Ibaraki 305-8575, Japan.
BMC Health Serv Res. 2012 Aug 4;12:239. doi: 10.1186/1472-6963-12-239.
Japan is setting the pace among aging societies of the world. In 2005, Japan became the country with the highest proportion of elderly persons in the world. To deal with the accelerated ageing population and with an increased demand for long-term care services, in April 2000 the Japanese government introduced a mandatory social Long-Term Care Insurance System (LTCI), making long-term care services a universal entitlement for elderly. Overseas literature suggests that the effectiveness of a home visiting program is uncertain in terms of preventing a decline in the functional status of elderly individuals. In Japan, many studies regarding factors associated with LTC service utilization have been conducted, however, limited evidence about the effect of LTC services on the progression of recipient disability is available.
Data were obtained from databases of the LTC insurer of City A. To examine the effect of in-home and community-based services on disability status of recipients, a survival analysis in a cohort of moderately disabled elderly people, was conducted.
The mean age of participants was 81 years old, and females represented 69% of the participants. A decline or an improvement in functional status, was observed in 43% and 27% of the sample, respectively. After controlling for other variables, women had a significantly greater probability of improving their functional status during all phases of the observation period. The use of "one service" and the amount of services utilized (days/month), were marginally (p = < 0.10) associated with a greater probability of improving their functional status at 12 months into the observation period.
The observed effects of in-home and community-based services on disability transition status were considered fairly modest and weak, in terms of their ability to improve or to prevent a decline in functional status. We suggest two mechanisms to explain these findings. First, disability transition as a measure of disability progression may not be specific enough to assess changes in functional status of LTCI recipients. Secondly, in-home and community-based services provided in City A, may be inappropriate in terms of intensity, duration or quality of care.
日本在全球老龄化社会中处于领先地位。2005 年，日本成为全球老年人口比例最高的国家。为了应对人口老龄化加速和对长期护理服务需求的增加，2000 年 4 月，日本政府推出了强制性的社会长期护理保险制度（LTCI），使长期护理服务成为老年人的普遍权益。国外文献表明，家庭探访计划在预防老年人身体功能下降方面的效果尚不确定。在日本，已经进行了许多关于与长期护理服务使用相关的因素的研究，但是，关于长期护理服务对受助人残疾进展的影响的证据有限。
数据来自 A 市长期护理保险公司的数据库。为了检验家庭和社区服务对受助人残疾状况的影响，对一组中度残疾的老年人进行了队列生存分析。
参与者的平均年龄为 81 岁，女性占参与者的 69%。样本中分别有 43%和 27%的人的功能状态下降或改善。在控制其他变量后，女性在观察期的所有阶段改善其功能状态的可能性都显著更大。在观察期的 12 个月内，使用“一项服务”和使用的服务量（天/月）与改善功能状态的可能性呈边际相关（p<0.10）。
观察到的家庭和社区服务对残疾转变状态的影响被认为是相当适度和微弱的，因为它们改善或防止功能状态下降的能力有限。我们提出了两种机制来解释这些发现。首先，作为残疾进展衡量标准的残疾转变可能不够具体，无法评估长期护理保险受助人的功能状态变化。其次，A 市提供的家庭和社区服务在强度、持续时间或护理质量方面可能不适当。
