日本有照护需求的老年人的住房调整和长期护理机构入住情况。

Housing Adaptations and Long-Term Care Facility Admissions among Older Adults with Care Needs in Japan.

机构信息

Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Research Department, Dia Foundation for Research on Ageing Societies, Tokyo, Japan.

Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.

出版信息

J Am Med Dir Assoc. 2024 Dec;25(12):105290. doi: 10.1016/j.jamda.2024.105290. Epub 2024 Sep 28.

DOI:10.1016/j.jamda.2024.105290

PMID:39353575

Abstract

OBJECTIVES

Housing adaptations may contribute to aging in place for older adults with care needs by reducing the risk of long-term care facility (LTCF) admissions, but this association remains unclear. We examined the association between housing adaptations and LTCF admissions among older adults with care needs.

DESIGN

Retrospective cohort study using data from a Japanese municipality.

SETTING/PARTICIPANTS: Adults aged ≥65 years who were newly certified with care needs under the public long-term care insurance system between April 2014 and March 2016.

METHODS

The study exposure was the implementation of insurance-covered housing adaptations (maximum covered cost: ¥200,000) during the 2 years after certification. Based on this exposure, participants were assigned to a non-implementation group (no housing adaptations), sub-maximum cost group (housing adaptations below the maximum cost), or maximum cost group (housing adaptations at the maximum cost). A Fine-Gray subdistribution hazards model was used to analyze the associations between the exposure groups and new LTCF admissions after adjusting for various risk factors. Death was regarded as a competing risk, and participants were followed until March 2022.

RESULTS

Among 4610 participants, 1261 (27.3%) had implemented housing adaptations. Among these, 943 (74.8%) were in the sub-maximum cost group and 318 (25.2%) were in the maximum cost group. During the follow-up period (median: 51 months), the incidence of LTCF admission was 3.9/1000 person-months in the non-implementation group, 3.8/1000 person-months in the sub-maximum cost group, and 2.8/1000 person-months in the maximum cost group. The adjusted subdistribution hazard ratio of LTCF admission (reference: non-implementation) was 0.90 (95% CI: 0.75-1.08) for the sub-maximum cost group and 0.67 (0.49-0.93) for the maximum cost group.

CONCLUSIONS AND IMPLICATIONS

Housing adaptations can support aging in place for older adults with care needs. Health care professionals and policymakers should consider the suitability of housing environments to reduce the risk of institutionalization.

摘要

目的

住房改造可以通过降低长期护理机构（LTCF）入院的风险，帮助有护理需求的老年人实现就地养老，但这种关联尚不清楚。我们研究了有护理需求的老年人的住房改造与 LTCF 入院之间的关系。

设计

利用日本一个市的居民数据进行的回顾性队列研究。

地点/参与者：2014 年 4 月至 2016 年 3 月期间，根据公共长期护理保险制度新认定有护理需求的 65 岁及以上成年人。

方法

本研究的暴露因素是在认证后 2 年内实施保险覆盖的住房改造（最高覆盖费用：200,000 日元）。基于这一暴露因素，参与者被分配到非实施组（未进行住房改造）、次最高费用组（住房改造费用低于最高费用）或最高费用组（住房改造费用达到最高费用）。采用 Fine-Gray 亚分布风险模型，在调整各种风险因素后，分析暴露组与新的 LTCF 入院之间的关联。死亡被视为竞争风险，参与者随访至 2022 年 3 月。

结果

在 4610 名参与者中，有 1261 人（27.3%）实施了住房改造。其中，943 人（74.8%）在次最高费用组，318 人（25.2%）在最高费用组。在随访期间（中位数：51 个月），非实施组的 LTCF 入院发生率为 3.9/1000 人月，次最高费用组为 3.8/1000 人月，最高费用组为 2.8/1000 人月。调整后的 LTCF 入院亚分布风险比（参照：非实施组）为次最高费用组 0.90（95%CI：0.75-1.08），最高费用组 0.67（0.49-0.93）。