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This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31–17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86–17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47–13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42–2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92–5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia. Interrupted time series (ITS). We used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012–2014; post-intervention: 2016–2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction. The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03–0.49; narrow definition: IRR = 0.15, CI = 0.03–0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase. The impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether there are disparities in the utilization of home-based care services according to income level among people aged 75 years or older in Japan. The research team used administrative claims data from April 2014 to March 2018 for people aged 75 years or older in Fukuoka Prefecture. Subjects were categorized according to income level using medical insurance claim data. Associations between income level and usage days of inpatient care, outpatient care, home medical care, and usage number of home-based long-term care (LTC) services were evaluated. Furthermore, medical and LTC costs were evaluated and adjusted for gender, age, and level of LTC needs. The team used generalized linear models (GLMs) to estimate medical and LTC services utilization, as well as the potential influence of gender, age, care needs level, and death as risk factors. The study analyzed 31,322 subjects, among whom 17,288 were in low-, 12,755 were in middle-, and 1399 were in high-income groups. The results of GLMs showed the number of home medical care days was 59.45, 62.24, and 69.66 days for users from low-, middle-, and high-income groups, respectively. Correspondingly, the number of home-based LTC services used was 668.84, 709.59, and 833.14 times. This study suggests that older adults with lower incomes had relatively low utilizations of home-based care services and high utilizations of nonhome-based LTC services. Policymakers should implement policies focused on people who need care to tackle socioeconomic inequalities in home-based care. [ABSTRACT FROM AUTHOR]

Aim: This study examined whether there is an association between continuous care rehabilitation (CR) and the risk of fracture hospitalization among people with Parkinson's disease (PwP) aged >75 years with mild‐to‐moderate care needs level. Methods: A retrospective study design based on the merging of medical claims and long‐term care insurance claims data was used. Before propensity score matching, of the 2177 participants, 222 received continuous CR, whereas 1955 did not. After matching using a 1:4 ratio, we identified 222 patients in the CR group and 888 patients in the non‐CR groups. We carried out a survival analysis to clarify the association between CR and the risk of fracture hospitalization. Results: After matching, there was a significant difference between the CR and non‐CR groups in 3 years (stratified log‐rank test by age P = 0.036) and in 4 years (stratified log‐rank test by age P = 0.011). The CR group was significantly associated with delays of hospital admission due to fracture within 3 years (hazard ratio 0.54; 95% confidence interval 0.29–0.99; P = 0.047) and within 4 years (hazard ratio 0.52; 95% confidence interval 0.30–0.88; P = 0.010). Conclusions: Our study showed that older people with Parkinson's disease who continuously received CR had a lower risk of fracture hospitalization in 3 and 4 years than those who did not receive CR or received interrupted CR. Considering our participants with a mild‐to‐moderate care needs level, a sustainable CR service might benefit people with Parkinson's disease from an early time when their activities of daily living are still intact and cognitive function has not deteriorated. Geriatr Gerontol Int 2022; 22: 628–634. [ABSTRACT FROM AUTHOR]

This study aimed to comprehensively evaluate whether income affects long-term health outcomes for older patients who underwent percutaneous coronary intervention (PCI) provided by a universal health coverage system. Data were from the Latter Stage Elderly Healthcare Insurance database in Fukuoka Prefecture, Japan. A total of 5625 individuals aged ≥65 years who underwent PCI in 2014–2016 were included. Cox proportional hazards models were used to assess the association between income status and the incidence of health outcomes. With a median follow-up of 1095 days, 554 acute myocardial infarction (AMI) cases, 1075 stroke cases, 1690 repeat revascularization cases, and 1094 deaths were observed. Risk of all-cause mortality decreased significantly with increasing income level in both unadjusted and adjusted Cox regression models. Patients in the low-income level had a significantly higher rate of AMI (log-rank P = 0.003), stroke (log-rank P = 0.039), and all-cause mortality (log-rank P = 0.001) compared with patients in the high-income level. Observed rates for repeat revascularization also were high in the first year after PCI. In the Japanese universal health setting, low-income patients had a comparatively higher mortality risk after PCI. Poor long-term outcomes might be attributed to patients' baseline characteristics rather than treatment processes. [ABSTRACT FROM AUTHOR]

Psychological factors affect chronic pain and may lead to inactivity after total knee arthroplasty (TKA). This study aimed to determine whether using an activity diary for early postoperative rehabilitation after TKA reduced pain and improved physical functioning and psychological factors. In this non-randomized controlled trial (intervention group: n = 140; control group: n = 150), postoperative rehabilitation with physical and occupational therapy was performed for both groups, and self-monitoring using an activity diary one week postoperatively was implemented for the intervention group. The outcome variables were the numerical rating scale of pain, Timed Up & Go Test score, timed 10 m walk test score, the Pain Catastrophizing Scale (PCS), and the Pain Self-Efficacy Questionnaire (PSEQ). The data were analyzed using ANOVA with post hoc tests. Time-by-group interactions were obtained for PCS and PSEQ (p <.05), which were both more favorable in the intervention group. The intervention group showed greater improvement in PCS and PSEQ four weeks postoperatively, compared with the control group (p <.05). However, no significant results were observed for neither physical performance measures assessed. These results indicated that including an activity diary increased postoperative rehabilitation effectiveness, improved pain catastrophizing and pain self-efficacy. An activity diary is an effective and feasible addition to postoperative care for TKA patients. [ABSTRACT FROM AUTHOR]

The fast-growing prevalence of Parkinson's disease (PD) creates a heavy burden for society and the health care system. Although different ways to mitigate the economic burden of PD have been discussed in the literature, including several effective treatments, few studies have paid attention to the effect of care rehabilitation (CR) on PD costs over a long-term care period. This study tracked medical expenses, care costs, and total costs of elderly individuals with PD for 3 years based on medical claims data merged with long-term care insurance (LTCI) claims data, and determined whether CR reduced PD costs. Using a retrospective, longitudinal cohort design, 3950 elderly individuals with PD who received LTCI services from April 2014 to March 2017 in Fukuoka Prefecture, Japan were followed. PD costs were compared between the CR group and the non-CR group, and a hierarchical linear model was used to examine whether CR was associated with medical expenses, care costs, and total costs. The mean value of total costs in fiscal years 2014, 2015, and 2016 were ¥3,124,944 (US$29,504), ¥3,328,398 (US$31,425), and ¥3,615,892 (US$34,140), respectively. In a hierarchical linear model, CR alone was not associated with medical expenses and care costs; additionally, CR had a positive association with higher total costs. However, the interaction term between CR and baseline care needs level significantly reduced care costs and total costs. That indicates that if older PD patients with higher care needs level receive CR, their care costs and total costs will be reduced. Further research is needed to clarify how CR reduces these patients' costs. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) prevalence has increased globally with considerable morbidity and economic burden at both individual and national levels. Japan is the first and only country that has introduced a nationwide lifestyle guidance intervention program to manage and control MetS. We conducted a quasi-experiment approach—regression discontinuity design—to evaluate the impact of this intervention on health outcomes at the population level. We retrospectively collected data of adults aged ≥35 years who participated in health checkups in 2015. Age in 2015 was used as the assignment variable, and an age of 40 years old was the threshold because those with MetS aged ≥40 were required to receive lifestyle guidance intervention. Among 26,772 MetS adults, those who received the intervention had significant reductions in obesity measurements (bodyweight, waist circumference, and body mass index [BMI]) after 1 year of this intervention. Blood pressure was also significantly reduced in men after 1 year of undertaking the intervention. The results were similar when including demographic, socioeconomic, and behavioral covariates and using alternative functional forms to estimate the impact, or when bandwidths around intervention thresholds were changed. Our results showed that lifestyle guidance intervention for MetS has an important impact on weight loss and blood pressure reduction at the population level. This intervention could address the high burden of obesity and cardiovascular diseases in Japan and other countries with an unmet need for MetS prevention and management. • Japan has introduced a lifestyle guidance intervention program since 2008. • This program targets middle-aged people with metabolic syndrome. • This study evaluated the impact of this program at the population level. • We applied a quasi-experiment approach, which may be less affected by confounders. • Significant decreases in body weight and blood pressure were evident. [ABSTRACT FROM AUTHOR]