Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyu Toranomon Bldg, 1-21-19 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
BMC Health Serv Res. 2023 Aug 29;23(1):916. doi: 10.1186/s12913-023-09890-x.
Housing adaptations are aimed at minimizing the mismatch between older adults' functional limitations and their building environments. We examined the association of housing adaptations with the prevention of care needs level deterioration among older adults with frailty in Japan.
The subjects comprised individuals who were first certified as having care support levels (defined as frail, the lowest two of seven care needs levels) under the public long-term care insurance systems between April 2015 and September 2016 from a municipality close to Tokyo. The implementation of housing adaptations was evaluated in the first six months of care support certification. Survival analysis with Cox proportional hazards model was performed to examine the association between housing adaptations and at least one care needs level deterioration, adjusting for age, sex, household income level, certified care support levels, cognitive function, instrumental activities of daily living, and the utilization of preventive care services (designed not to progress disabilities). We further examined the differences in the association of the housing adaptation amount by categorizing the subjects into the maximum cost group (USD 1,345-1,513) or not the maximum cost group (< USD 1,345). All the subjects were followed until the earliest of deterioration in care needs level, deaths, moving out of the municipality, or March 2018.
Among 796 older adults, 283 (35.6%) implemented housing adaptations. The incidence of care needs level deterioration was 19.3/1000 person-month of older adults who implemented housing adaptations, whereas 31.9/1000 person-month of those who did not. The adjusted hazard ratio (aHR) of care needs level deterioration was 0.69 (95% confidence interval (CI): 0.51-0.93). The aHRs were 0.51 (95% CI: 0.31-0.82) and 0.78 (95% CI: 0.57-1.07) in the maximum and not maximum cost groups, respectively.
Housing adaptations may prevent care needs level deterioration of older adults with frailty. Policymakers and health professionals should deliver housing adaptations for older adults at risk of increasing care needs.
住房改造旨在最大限度地减少老年人的功能障碍与建筑环境之间的不匹配。我们研究了住房改造与日本衰弱老年人护理需求水平恶化预防之间的关系。
研究对象包括 2015 年 4 月至 2016 年 9 月期间，在东京附近的一个市首次被认定为公共长期护理保险制度下护理支持水平（定义为虚弱，七个护理需求水平中最低的两个）的人。在护理支持认证的前六个月评估住房改造的实施情况。采用 Cox 比例风险模型进行生存分析，以检查住房改造与至少一个护理需求水平恶化之间的关系，调整因素包括年龄、性别、家庭收入水平、认证的护理支持水平、认知功能、日常生活活动能力以及预防保健服务的利用（旨在防止残疾恶化）。我们还通过将受试者分为最大成本组（1345-1513 美元）和非最大成本组（<1345 美元），进一步研究了住房改造量的差异对该关联的影响。所有受试者均随访至护理需求水平恶化、死亡、搬出该市或 2018 年 3 月的最早时间。
在 796 名老年人中，283 人（35.6%）实施了住房改造。实施住房改造的老年人护理需求水平恶化的发生率为 19.3/1000 人月，而未实施住房改造的老年人为 31.9/1000 人月。护理需求水平恶化的调整后危险比（aHR）为 0.69（95%置信区间（CI）：0.51-0.93）。最大成本组和非最大成本组的 aHR 分别为 0.51（95%CI：0.31-0.82）和 0.78（95%CI：0.57-1.07）。
住房改造可能预防衰弱老年人护理需求水平的恶化。政策制定者和卫生专业人员应为有增加护理需求风险的老年人提供住房改造。
