Changes of Care Levels of Frail Elderly Individuals After Introduction of Long-Term Nursing Care Insurance System / 日本農村医学会雑誌

ABSTRACT

  A long-term care insurance law was enacted in 2000 for the purpose of socializing elderly care. Since then, the Japanese government has come to shoulder an unexpected financial burden because of a large increase in the number of the slightly frail elderly. Based on the need of frail elderly individuals, five care levels were established by the insurance law. Predictive factors for changes of the care level of such individuals are not yet clear. We conducted an analysis of the relationship between changes of care levels of frail elderly people residing in Izumo City, Shimane, and such factors as gender, age, activity of daily life (ADL) and care services utilization, in a cohort study of 1,965 certified elderly individuals in 2000, and of 2,547 such individuals in 2002. We arbitrarily set the care levels into three categoriesmaintenance/improvement, deterioration, and death; we then tracked the care levels of each cohort over a two-year period. At the end of 2-year tracking, 39.9% of the 2000 cohort were in the maintenance/improvement level, 37.7% in deterioration and 22.4% had died; for the 2002 cohort, the results were 51.8%, 25.8% and 22.5%, respectively. The elderly in all care levels in the 2002 cohort, especially those with the higher ADL (support necessary and care level 1), improved their ADL but showed no significant differences in death rate, compared with the 2000 cohort. The certification method of care level for long-term care did not substantially change between 2000 and 2004. The improvement of care level change in the 2002 cohort was not related to either level of care or dementia, or to utilization rates of services at home. Therefore, the attitude of the users of services and the quality of home care may have contributed to the improvement of care levels from 2000 to 2002.