WATANABE Shuichiro Obirin University, Department of Gerontology, Graduate School of International Studies, Associate professor, 大学院・国際学研究科・老年学専攻, 助教授 (20230964)
山田 敦弘 財団法人東京都高齢者研究, 福祉振興財団・東京都老人総合研究所, 協力研究員
|Budget Amount *help
¥3,600,000 (Direct Cost : ¥3,600,000)
Fiscal Year 2004 : ¥700,000 (Direct Cost : ¥700,000)
Fiscal Year 2003 : ¥700,000 (Direct Cost : ¥700,000)
Fiscal Year 2002 : ¥2,200,000 (Direct Cost : ¥2,200,000)
Objective : To ascertain predictors for the onset of different levels of certification of long-term care need among older adults living independently in community.
Methods : Out of all residents aged 65 years and over living in Y town, Niigata prefecture, Japan (n=1,673),1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among those participants, 1,229 persons (79.6% of responders) were ranked as J0 or J1,based on the hierarchical ADL level classification proposed by the Japanese Ministry of Health, Labor and Welfare. They were followed up for subsequent 3 years and 4 months to see whether they survived without certification of long-term care need or had the onset of either levels of certification of long-term care need ; "mild level" who were certificated as level "needing support" and 1 of certification of long-term care need, or "severe level" as level 2- 5. Cox proportional hazard model with a stepwise method was used to identity the most par
simonious combination of risk factors for each type of long-term care need certification.
Results : Of those who were followed up, 1,151 persons showed no BADL-disability at baseline nor died before application for long-term care during the follow-up and were thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had the onset of "mild level" and "severe level" during the follow-up, respectively. The final model for prediction of both "mild level" and "severe level" included advanced age (OR for 5 year-increment:1.81[95%CI,1.40-1.52] and 2.14[1.65-2.79], respectively), history of hospitalization during past 1 year (OR for presence:2.67[1.25-5.70] and 2.28[1.07-4.88], respectively). Walking ability (OR for both unable and with difficulty:4.92;95%CI 2.26-10.75 vs.either unable or with difficulty:3.54;95%CI:1.64-7.68) and chewing ability (OR for limited:3.04;95%CI:1.53-6.04) were predictive only for "mild level", while poor cognitive function (OR for 1 point-decrement:1.13[1.03-1.23]) and lower IADL function (OR for 1 point-decrement:3.01[1.49-6.06]) were only for "severe level".
Conclusions : Among older adults living independently in community lower physical function such as walking or chewing ability contributed to the subsequent onset of mild level-certification of long-term care need. On the other hand, lower cognitive or IADL function contributed to the subsequent onset of severe level-certification. Less