Population ageing and wellbeing: lessons from Japan's long-term care insurance policy

Tamiya, Nanako; Noguchi, Haruko; Nishi, Akihiro; Reich, Michael R.; Ikegami, Naoki; Hashimoto, Hideki; Shibuya, Kenji; Kawachi, Ichiro; Campbell, John C.

doi:10.1016/s0140-6736(11)61176-8

Cited by 459 publications

(422 citation statements)

References 32 publications

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“…Our primary outcome is dementia symptomatology assessed by a standardized in-home assessment. The Japanese government established a national LTCI scheme in 2000 (22). Under the LTCI, a certification committee in each municipality dispatches a trained investigator to an applicants' home to evaluate their eligibility for elderly care (e.g., home helpings).…”

Section: Methodsmentioning

confidence: 99%

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Increased risk of dementia in the aftermath of the 2011 Great East Japan Earthquake and Tsunami

Hikichi

Aida

Kondo

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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No previous study has been able to examine the association by taking account of risk factors for dementia before and after the disaster. We prospectively examined whether experiences of a disaster were associated with cognitive decline in the aftermath of the 2011 Great East Japan Earthquake and Tsunami. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 km west of the epicenter 7 mo before the earthquake and tsunami. Approximately 2.5 y after the disaster, the follow-up survey gathered information about personal experiences of disaster as well as incidence of dementia from 3,594 survivors (82.1% follow-up rate). Our primary outcome was dementia diagnosis ascertained by in-home assessment during the follow-up period. Among our analytic sample (n = 3,566), 38.0% reported losing relatives or friends in the disaster, and 58.9% reported property damage. Fixed-effects regression indicated that major housing damage and home destroyed were associated with cognitive decline: regression coefficient for levels of dementia symptoms = 0.12, 95% confidence interval (CI): 0.01 to 0.23 and coefficient = 0.29, 95% CI: 0.17 to 0.40, respectively. The effect size of destroyed home is comparable to the impact of incident stroke (coefficient = 0.24, 95% CI: 0.11 to 0.36). The association between housing damage and cognitive decline remained statistically significant in the instrumental variable analysis. Housing damage appears to be an important risk factor for cognitive decline among older survivors in natural disasters.instrumental variable analysis U p to two-thirds of the affected populations in the 2011 Great East Japan Earthquake and Tsunami were older residents who were 60 y old or older (1). Recovery after major disaster poses a unique set of challenges for the elderly population, including disruption of medical care for preexisting conditions, preexisting functional limitations that impede recovery, and social isolation in the aftermath of housing loss and resettlement. A particular concern for older survivors is the potential risks of cognitive decline. In the 2011 earthquake and tsunami, an estimated 340,000 residents were displaced as a result of widespread destruction to residential properties. In turn, as a direct consequence of residential dislocation and resettlement in unfamiliar surroundings, many seniors experienced disorientation that could hasten cognitive decline (2). Psychological trauma, including posttraumatic stress disorder (PTSD) symptoms (3) and the onset of depression (4), may have additionally contributed to this risk.Two years after the 2011 Great East Japan Earthquake and Tsunami, a cross-sectional study found that 36.0% of seniors who moved to temporary housing in Kesen-numa city were suffering from dementia symptoms (5). Another cross-sectional study of seniors affected by the disaster reported that 47.9% showed signs of mild cognitive impairment, and an additional 16.0% of respondents were diagnosed as having dementia (6). However, ...

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Section: Methodsmentioning

confidence: 99%

“…The initial certification is valid for 6 mo, after which periodic reassessments are generally conducted every 12 mo (25). The certified persons can require the reassessment before the expiration date, when their health status radically changes (22).…”

Section: Methodsmentioning

confidence: 99%

Increased risk of dementia in the aftermath of the 2011 Great East Japan Earthquake and Tsunami

Hikichi

Aida

Kondo

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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“…The increasing elderly population in Japan is projected to be accompanied by higher rates of dementia [7] and disability [8]. It is plausible that MCR may be associated with increased risk of health-related outcomes among older adults given that its cognitive and motoric components are individually associated with increased risk of disability.…”

Section: Introductionmentioning

confidence: 99%

Motoric Cognitive Risk Syndrome: Association with Incident Dementia and Disability

Doi

Shimada

Makizako

et al. 2017

JAD

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Abstract.Background: It is important to examine the etiology of motoric cognitive risk syndrome (MCR) and its association with dementia and disability to obtain biological insights and to develop preventive strategies. Objective: This study aimed to examine the association of MCR with incidence of dementia and disability in a Japanese community-dwelling sample of older adults. Methods: Participants were 4,235 older adults (50% women, mean age: 72.0 years). MCR was diagnosed at baseline using established criteria in non-demented seniors with self-reported cognitive complaints and slow gait. Incident cases of dementia were identified from insurance data monthly. Disability was regarded as certification by long-term care insurance. Results: At baseline, 265 participants (6.3%) met criteria for MCR. During follow-up (mean duration: 29 months), there were 138 incident cases of dementia (3.3%) and 207 incident cases of disability (4.9%). Cox-proportional hazards models, adjusted for demographical data, lifestyle, and medical conditions, showed that presence of MCR at baseline was a major risk factor for developing dementia (HR 2.49, 95%CI 1.52-4.10, p < 0.001). MCR also predicted risk for disability (HR 1.69, 95%CI 1.08-2.02, p < 0.001). Conclusions: MCR is helpful in the short-term prediction of risk for dementia and disability in the elderly Japanese population. Identification of seniors with MCR is recommended for early detection and instituting preventive measures for reducing the risk of dementia and disability.

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“…The Japanese Government initiated mandatory public LTCI in 2000, to help older people to lead lives that are more independent and to relieve the burdens of family carers. [3] LTCI system has made long-term care an explicit and universal entitlement for every Japanese older people based strictly on physical and mental status. [4][5][6] A long-term care health facility provides day services, which include outpatient day long-term care; outpatient rehabilitation; short-stay or long-stay services, which include long-term care of daily life; and rehabilitation for residents.…”

Section: Introductionmentioning

confidence: 99%

Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study

Takashima¹,

Murata

Saeki

2016

Disability and Rehabilitation

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Population ageing and wellbeing: lessons from Japan's long-term care insurance policy

Cited by 459 publications

References 32 publications

Increased risk of dementia in the aftermath of the 2011 Great East Japan Earthquake and Tsunami

Increased risk of dementia in the aftermath of the 2011 Great East Japan Earthquake and Tsunami

Motoric Cognitive Risk Syndrome: Association with Incident Dementia and Disability

Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study

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