Showing papers by "Katsuya Iijima published in 2019"

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

Abstract: The occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan. Medical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level. The mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34% of the sum, respectively. Every increase in one unit of the CCI scores was associated with a ¥257,000 (US$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures (p < 0.001; n = 29,915). Using a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone.

Living with Family yet Eating Alone is Associated with Frailty in Community-Dwelling Older Adults: The Kashiwa Study.

Abstract: Eating alone is related to depression, nutritional risk, and mortality. These effects are also influenced by living status. However, little is known about the relationship between eating alone despite living with family and frailty. This study explores the relationship of eating alone and living status with frailty in community-dwelling older adults. Cross-sectional study. Kashiwa city, Chiba prefecture, Japan; randomly selected community-dwelling older adults (aged 65 years and over). Eating status was assessed by the question, “Do you eat meals with anyone, at least once a day: yes or no?” Frailty was defined by Kihon Checklist (KCL) score 8 or over. Domains of frailty were divided into instrumental activities of daily living (IADL), physical strength, nutrition, eating, socialization, memory, and mood, based on KCL categories. Binary logistic regression analysis was used, adjusting for age, years of education, chronic diseases, number of teeth and cognitive function. Among the total of 1,914 participants, 49.8% were male, and the overall mean age was 72.9 ± 5.5 years. Of all participants, 56 (5.9%) of men and 112 (11.7%) of women were frail. Older adults who ate alone despite living with others were more likely to be frail (OR 2.49, 95%CI 1.1–5.5 for men and OR 2.16, 95%CI 1.0–4.5 for women). Of particular note, eating and living status were associated with lower physical strength and mood in men, whereas in women these statuses were associated with lower scores for IADL, socialization, memory, and mood. Eating alone despite living with others was associated with high frailty in both genders; however, the pathways were different between genders. These results might help yield a simple, fundamental intervention approach to multifaceted frailty, reflecting gender and associated high-risk domains.

Antipsychotic use and related factors among people with dementia aged 75 years or older in Japan: A comprehensive population-based estimation using medical and long-term care data

Abstract: Objectives Antipsychotics are used to manage the behavioral and psychological symptoms of dementia (BPSD), despite their association with greater risks for mortality and cerebrovascular events. Previous studies in Japan have estimated the prevalence of antipsychotics among older adults who took antidementia drugs. Using long-term care (LTC) data, we aimed to obtain more accurate estimates of the prevalence of antipsychotics and to determine factors related to their use in older adults with dementia. Methods Medical and LTC claims data and LTC certification data between April 2012 and September 2013 were obtained from a middle-sized suburban city. The 1-year prevalence of antipsychotic use was estimated among individuals with probable dementia aged greater than or equal to 75 years who were prescribed antidementia drugs and/or had dementia based on LTC needs certification data. Results Of 25 919 participants, 4865 had probable dementia and 1506 were prescribed antidementia drugs. The prevalence of antipsychotics among participants with probable dementia was 10.7%, which was lower than that in those who were prescribed antidementia drugs (16.4%). Among participants with probable dementia with LTC certification data available (N = 4419), lower cognitive function (vs mild; adjusted odds ratio 2.16, 95% confidence interval 1.63-2.86), antidementia drug use (2.27, 1.84-2.81), and institutional LTC services use (2.34, 1.85-2.97) were associated with greater odds of antipsychotic use, whereas older age (greater than or equal to 92 years) was associated with lower odds (vs less than 77 years; 0.42, 0.27-0.65). Conclusions These findings may be useful for estimating the burden of BPSD and for taking measures to reduce inappropriate antipsychotic prescription.

Factors associated with long-term urinary catheterisation and its impact on urinary tract infection among older people in the community: a population-based observational study in a city in Japan.

Abstract: Objectives This study aimed to identify factors associated with long-term urinary catheterisation (LTUC) in community-dwelling older adults and to evaluate the risk of urinary tract infection (UTI) among people with LTUC. Design Population-based observational study. Setting Medical and long-term care insurance claims data from one municipality in Japan. Participants People aged ≥75 years living at home who used medical services between October 2012 and September 2013 (n=32 617). Outcome measures (1) Use of LTUC, defined as urinary catheterisation for at least two consecutive months, to identify factors associated with LTUC and (2) the incidence of UTI, defined as a recorded diagnosis of UTI and prescription of antibiotics, in people with and without LTUC. Results The 1-year prevalence of LTUC was 0.44% (143/32 617). Multivariable logistic regression analysis showed that the male sex, older age, higher comorbidity score, previous history of hospitalisation with in-hospital use of urinary catheters and high long-term care need level were independently associated with LTUC. The incidence rate of UTI was 33.8 and 4.7 per 100 person-years in people with and without LTUC, respectively. According to multivariable Poisson regression analysis, LTUC was independently associated with UTI (adjusted rate ratio 2.58, 95% CI 1.68 to 3.96). Propensity score-matched analysis yielded a similar result (rate ratio 2.41, 95% CI 1.45 to 4.00). Conclusions We identified several factors associated with LTUC in the community, and LTUC was independently associated with the incidence of UTI.

地域在住高齢者における身体・文化・地域活動の重複実施とフレイルとの関係

Abstract: Objective The goal of the study was to assess the relationships of the frequency (more than one time per week) of various activities to frailty among independent elderly people in Japan.Methods Survey data were collected from 73,341 community-dwelling elders who were not certified as Needing Long-Term Care. Basic checklist survey items developed by the Ministry of Health, Labour and Welfare were used along with exhaustive items on the weekly physical, cultural, community, and volunteer activities of the respondents. The effects of the frequencies of each activity with and without frailty were estimated. The relationship between frailty and pre-frailty was analyzed in a multinomial logistic regression model regarding involvement in activities and controlling for the effects of gender, age, and with non-frailty as a reference category.Results Data on 49,238 individuals in the study area not certified as Needing Long-Term Care (24,632 males and 24,606 females), corresponding to 67% of all elderly (aged 65 or more years) Japanese people were analyzed. About 65.9% of the respondents reported that they engaged in physical activities, 78.8% reported cultural activities, and 14.9% reported community social activities. The percentages classified as frail and pre-frail were 12.8% and 22.7%, respectively. All of the activities significantly related to frailty. The adjusted odds ratio (95% CI) of frailty among the respondents that engaged in all the types of activity was: 2.19 (1.71, 2.80) among those that reported no physical activities, 1.48 (0.91, 2.43) among those with no cultural activities, and 2.09 (1.80, 2.44) among those with no community social activities. The adjusted odds ratio on frailty for the three groups reporting one type of activity ranged from 5.40 to 6.42, which was statistically significant, and the adjusted odds ratio on the group reporting no activities was 16.41 (14.02, 19.21). These results indicate that the extent of frailty increased as the number of activities decreased.Conclusions This cross-sectional study found that frailty among elders in Japan was separately associated with participation in cultural activities, social community activities, and physical activities. Frailty was more severe among those with less participation. This result suggests that, for elders who find it difficult to participate in physical activities, engaging in cultural or community social activities might help to prevent or delay frailty.

Community-based program promotes interprofessional collaboration among home healthcare professionals: A non-randomized controlled study.

Abstract: Aim To evaluate the effect of an interprofessional collaboration (IPC) promotion program among community healthcare professionals. Methods A non-randomized controlled study was carried out. Study participants were home healthcare-related professionals in a suburban city near Tokyo; program participants were compared with non-participants. The program consisted of two workshops each 2 h long and 4 months apart. The first workshop focused on developing a community resource map, and discussing community strengths and features. The second focused on examining a case of transitional care from hospital to home. Mail surveys were carried out before the first workshop and 6 months after. The IPC level was examined using an established seven-domain scale. Analysis of covariance was used to examine the program effect by comparing baseline and 6-month data in the two groups. Results Altogether, 213 professionals participated (intervention: n = 141 vs control: n = 72); approximately 60% were women, with a mean age of 45.9 ± 10.2 years. There were significant between-group differences in baseline IPC score, age, type of profession and number of other educational opportunities. After adjusting for these variables, the IPC domains of "familiarity" and "meeting and talking" improved significantly in the intervention group as compared with the control group (P = 0.011 and 0.036, respectively). When the intervention group was split in two (two-time vs one-time participants), the improvement at 6 months was not significantly different between two- and one-time participants. Conclusions It is suggested that our program is effective to improve the IPC level; one-time participation might be enough to have expected improvement. Geriatr Gerontol Int 2019; 19: 660-666.

Multiple turns: Potential risk factor for falls on the way to the toilet

Abstract: Of the patients, 66.2% were female, and the age was 85.4 6.0 years. We surveyed prescribed drugs and provided home medical care services at the first home visit by a physician and again 3 months later. The use of home care services did not change for 3 months. Differences were evaluated using the t-test for continuous variables, and the χ-test for percentages. We defined polypharmacy as prescription of five or more medications, and potentially inappropriate medications (PIM) according to the Screening Tool for Older Persons’ appropriate Prescriptions for Japanese (STOPP-J). The study was approved by the ethics review board of the Graduate School of Medicine, The University of Tokyo (11391-[3]). The number of prescribed medications per patient was 4.3 3.2 at the first home visit by a physician, and 4.7 3.1 3 months later (P = 0.01, paired t-test). The number of patients prescribed PIM was 36 (45.0%) at the commencement of the home visit, and 38 (47.5%) after 3 months. The most frequently prescribed therapeutic class of PIM was hypnotics, followed by diuretics. The number of PIM per patient was 0.73 0.94 at the first home visit by a physician, and 0.73 0.90 3 months later (not significant). We compared the non-polypharmacy group and polypharmacy group at the first home visit (Table 1). The polypharmacy group had a significantly higher proportion of nurse home visits. We also compared patients with an increased number of drugs at 3 months after the first home visit by a physician and those without an increase. The number of prescribed drugs in the group of patients with an increased number of medications at 3 months after the first home visit by a physician was significantly lower at the first home visit than the group of patients without an increase. The polypharmacy group used home visits by nurses more frequently compared with the non-polypharmacy group. We speculated that the increased number of prescribed drugs after 3 months was related to medication non-compliance, the number of comorbidities and adverse drug reactions. The present study was carried out at three clinics in Tokyo. To clarify the effects of home medical care services on drug prescriptions, we should investigate a larger population of patients receiving home medical care services.

Study on Stumbles of the Elderly from a Depth Perception Dependency Test

Abstract: In this paper, we investigate the relationship between the depth perception and an approaching motion toward an object. We propose the depth perception dependency test, which is the combination of tests of a motion and depth perception based on the situation that an object is placed on the human’s pathway. Firstly, as the motion test, we set the ball approach motion and asked elderly participants to approach and contact a ball by their foot, because this motion is easy to measure and requires localization skill and motion planning skill. The swing/support legs positions at the toeoff time of the swing leg just before contacting the ball was analyzed. Secondly, as the depth perception test, the pseudo3D image test was proposed. The coordinate transformation model for the calculation of the depth perception ability was also proposed. Through the proposed test and the proposed model, it was clarified that the participants who are regarded as perceiving the strong visual illusion perceive the objects closer than its real position, and their swing leg toe off positions in the ball approaching motion were significantly farther than other participants. Thus, it can be concluded that there was a relationship between the depth perception and the approaching motion that is thought to be a higher risk of stumbles.