Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.
Dia Foundation for Research On Ageing Societies, Tokyo, Japan.
BMC Geriatr. 2022 May 20;22(1):444. doi: 10.1186/s12877-022-03100-9.
Accessible housing is crucial to maintain a good quality of life for older adults with functional limitations, and housing adaptations are instrumental in resolving accessibility problems. It is unclear to what extent older adults, who have a high risk of further functional decline, use housing adaptation grants acquired through the long-term care (LTC) insurance systems. This study aimed to examine the utilization of housing adaptation grants in terms of implementation and costs, for older adults with different types of functional limitations related to accessibility problems.
The study sample included individuals from a suburban city in the Tokyo metropolitan area who were certified for care support levels (indicative of the need for preventive care) for the first time between 2010 and 2018 (N = 10,372). We followed the study participants over 12 months since the care needs certification. We matched and utilized three datasets containing the same individual's data: 1) care needs certification for LTC insurance, 2) insurance premium levels, and 3) LTC insurance claims. We conducted a multivariable logistic regression analysis to estimate the likelihood of individuals with different functional limitations of having housing adaptations implemented. Afterward, we conducted a subgroup analysis of only older adults implementing housing adaptation grants to compare costs between groups with different functional limitations using the Mann-Whitney U and Kruskal-Wallis tests.
Housing adaptations were implemented among 15.6% (n = 1,622) of the study sample, and the median cost per individual was 1,287 USD. Individuals with lower extremity impairment or poor balance were more likely to implement housing adaptations (adjusted odds ratio (AOR) = 1.290 to AOR = 2.176), while those with visual impairment or lower cognitive function were less likely to implement housing adaptations (AOR = 0.553 to AOR = 0.861). Costs were significantly lower for individuals with visual impairment (1,180 USD) compared to others (1,300 USD).
Older adults with visual or cognitive limitations may not receive appropriate housing adaptations, despite their high risk of accessibility problems. Housing adaptation grants should include various types of services that meet the needs of older people with different disabilities, and the results indicate there may be a need to improve the system.
对于有功能障碍的老年人来说，无障碍住房至关重要，住房改造对于解决无障碍问题至关重要。目前尚不清楚有多少有进一步功能下降风险的老年人使用长期护理（LTC）保险系统获得的住房改造津贴。本研究旨在检查不同类型与无障碍相关的功能障碍的老年人在实施和成本方面对住房改造津贴的使用情况。
研究样本包括 2010 年至 2018 年间首次获得护理支持水平（表示需要预防性护理）认证的东京都郊区城市的个人（N=10,372）。我们在护理需求认证后对研究参与者进行了 12 个月的随访。我们匹配并利用了包含同一人数据的三个数据集：1）LTC 保险的护理需求认证，2）保险费水平，和 3）LTC 保险索赔。我们进行了多变量逻辑回归分析，以估计具有不同功能障碍的个体实施住房改造的可能性。之后，我们仅对实施住房改造津贴的老年人进行亚组分析，使用 Mann-Whitney U 和 Kruskal-Wallis 检验比较不同功能障碍组之间的成本。
研究样本中有 15.6%（n=1,622）实施了住房改造，人均中位数成本为 1,287 美元。下肢功能障碍或平衡能力差的个体更有可能实施住房改造（调整后的优势比（AOR）=1.290 至 AOR=2.176），而视力障碍或认知功能较低的个体则不太可能实施住房改造（AOR=0.553 至 AOR=0.861）。视力障碍者的费用明显低于其他人群（1,180 美元）（1,300 美元）。
尽管有较高的无障碍问题风险，但视力或认知障碍的老年人可能无法获得适当的住房改造。住房改造津贴应包括满足不同残疾老年人需求的各种类型的服务，结果表明可能需要改进该系统。
