Departmental Bulletin Paper Analysis of Changes in Elderly Peopleʼs Levels of Long-Term Care Needs and Related Factors With a Focus on Care Levels II and III
要介護高齢者の介護度維持と悪化の実態と関連要因の分析 - 介護度Ⅱ , Ⅲと介護サービスを焦点化して-

Yanagihara, Kiyoko  ,  Fujiu, Makoto  ,  Sano, Shizuka  ,  Takayama, Junichi  ,  Nishino, Tatsuya  ,  Tamamori, Yuya  ,  Sagae, Masahiko  ,  Samuta, Hikaru  ,  Hirako, Kouhei  ,  Sinohara, Moeko  ,  Tujiguti, Hiromasa  ,  柳原, 清子  ,  藤生, 慎  ,  佐野, 静香  ,  高山, 純一  ,  西野, 辰哉  ,  玉森, 祐矢  ,  寒河江, 雅彦  ,  佐無田, 光  ,  平子, 絋平  ,  篠原, もえ子  ,  辻口, 博聖

41 ( 2 )  , pp.93 - 103 , 2018-01-31 , Wellness and Health Care Society , ウェルネス・ヘルスケア学会
New preventative benefits will be offered in Japan from spring 2018 in conjunction with reforms to the long-term care insurance system. We examined the relationship between maintenance/deterioration of the level of long-term care and services and diseases over time using KDB<Kokuho database> from late-stage elderly (hereafter “late-stage KDB”) residing in City A, a medium-sized rural town. “Late-stage KDB” data from the 3-year period between 2012 and 2015 were combined, and 878 people requiring long-term care at levels II and III were included in the study. Based on the year 2012, we compared the groups requiring long-term care II and III. Furthermore, in comparison with 2015, we divided the subjects according to maintenance/deterioration of care level and compared the relevant factors between the groups.In 2015, the care level remained the same for 354 (40.3%) people, and deteriorated for 524 (59.7%), while long-term care benefits and medical costs increased. The rate of increase in the level of care needs was higher among those in care level II. With regard to services, multifunctional long-term care in small group homes and admission increased, and facility services accounted for 47%.On the other hand, in 2012, there were no differences with regard to service use or medical costs in the group of participants requiring long-term care levels II/III who experienced care maintenance/deterioration. This was because these services were already being used in City A. Maintenance rates were high in care facilities in the surrounding areas. Pathologically, the rates of respiratory, cerebrovascular, and cognition problems increased after 3 years. Logistic regression analysis showed no relationship between type of disease and maintenance/deterioration of care level. We believe that the reason for care deterioration is related to following the age-survival curve rather than service use.
我が国は 2018 年春より介護保険制度の新予防給付が始まり、制度改革の転換点にある。本研究は地方の中規模A市の後期高齢者医療データベース(以下〝後期 KDB〟)を使って、介護度の維持 / 悪化の経年的変化と介護サービス、疾病との関連を検討するものである。データは〝後期 KDB〟の 2012 年 -2015 年の3年分を結合し、要介護度ⅡとⅢの 878 人を対象とした。分析は 2012 年を基準として要介護度Ⅱ / Ⅲの群で比較し、さらに 2015 年との比較において維持群と悪化群で関連要因をみた。2015 年では介護度の維持が約 4 割で、6 割が悪化、要介護ⅡがⅢよりも悪化し、介護給付費および医療費は増大した。サービスでは小規模多機能と入所サービスが増え、施設入所は47%に至る。一方 2012 年度に遡って、要介護ⅡとⅢの維持 / 悪化群を比較すると、サービス利用および医療費に差はなかった。介護度の維持 / 悪化群に差が無かったのは、A 市では元来標準的にサービスが使われていたことが推察される。実際介護度維持率が高い地区は、サービス施設周辺地区であった。介護度悪化要因と疾病との関連では,3年後の群に呼吸器系、脳血管系、精神認知系疾患が増えていた。しかしロジスティック回帰分析では、疾病と維持 / 悪化に有意な関連はなかった。介護度悪化の理由は、介護サービス内容の関連はなく、加齢による生存率曲線(生命曲線)を辿っていると考えられる。

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