A three-year-follow-up study on the change in physical and mental functions of the aged by the level ofADL. Evaluation of data from the Japanese elderly care insurance certification of long-term care need.

Abstract

Using the value in which the physical and mental condition of elderly persons was converted into the amount of care required time, this paper estimates the average change of physical and mental functions according to the subject's sex and independence level of primary ADL (Activities of Daily Living) over a span of 3 years. The following comparative examination was also carried out: 1) Over a span of 3 years, how did the physical and mental functions of the elderly change? 2) Of the function items, which parts showed a change in function as time passed? 3) Was there any difference in terms of sex? 4) Was there an influence of the care service benefits from Long Term-care Insurance System on functional recovery? In Higashi-Osaka City, from October 1999 to March 2002, of the 20,393 elderly persons aged 65 years old and above who were administered a visit assessment to determine the level of care required, 10,812 persons who had been visited 3 or more times at intervals of 6 months to 1 year and had had data on their physical and mental conditions continuously obtained from them, were used as subjects. A "Multilevel Model Analysis" was conducted based on the ADL from the first visit which was divided into 1) almost independent, almost no need for nursing care (low-grade), 2) can lead an independent life if appropriate care is given (middle-grade), 3) unable to lead a normal day-today life without complete nursing care (severe-grade). For the basic model, the response variable was the hours spent for care required time, level 1 (i) was across multiple visit assessment occasions, level 2 (j) was multiple occasions nested within individuals, and the response variable was age at initial visit assessment and years from initial visit assessment (elapsed time). The prolongation of care required time during the 3 years was calculated at; low-grade male 19.3, middle-grade male 17.6, severe-grade male 2.6, low-grade female 15.2, middle-grade female 16.7, severe-grade female 2.2. The functions that changed over time were those asked in "complex movement" and "the physical hygienics field" items in the survey. These items showed a decrease in function thus increasing the level of required care. During 3 years the elderly care required time was prolongated. In low-grade and middle-grade, the use of nursing-care service did not prevent worsening of the care required level. In severe-grade an improvement was seen in the nursing-care condition. This may be due to the quantity of care provided. In examining the relationship of the care service and the care condition, it is necessary to look into the kind and quantity of severe-grade service that was used.