Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching
Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching
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改善虚弱的多因素干预对社区老年人长期护理保险认证风险、死亡和长期护理费用的影响：一项使用倾向评分匹配的准实验研究
DOI：
10.11236/jph.67.10_752
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
北村 明彦
中科院分区：
文献类型：
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作者：
横山 友里;新開 省二;清野 諭;光武 誠吾;西 真理子;村山 洋史;成田 美紀;石崎 達郎;野藤 悠;北村 明彦
目的 研究改善包含衰弱的抗阻运动以及营养和社会心理计划的多因素干预对社区老年人长期护理保险 (LTCI) 认证、死亡和长期护理 (LTC) 成本风险的影响。方法 来自 Hatoyama 队列研究（742 人）的 77 名个体（2011 年 47 名，2013 年 30 名）参与了多因素干预。非参与者来自同一队列（包括受邀参加多因素干预但拒绝的人）。我们以 1:2 的比例进行倾向评分匹配（干预组与非参与者组）。随后，选择了 70 名接受多因素干预的人和 140 名非参与者。使用 Cox 比例风险模型和广义线性模型（伽玛回归模型）比较 LTCI 认证和/或死亡的风险以及随访期间（32 个月）的平均 LTC 成本。结果 干预组的新 LTCI 认证发生率（每 1,000 人年）往往低于非参与者组（1.8 比 3.6），但根据 Cox 比例风险模型（风险比 = 0.51，95% 置信区间 [CI]= 0.17-1.54），这并不具有统计显着性。尽管LTC费用发生率并不显着，但干预组32个月内的平均累计LTC费用和随访期（1个月）的单位平均LTC费用分别为375,308日元和11,906日元/月，非参与组分别为1,040,727日元和33,460日元/月。根据伽玛回归模型，干预组的成本往往低于非参与者组（累积LTC成本：成本比= 0.36，95％CI = 0.11-1.21，P = 0.099；每单位随访期LTC成本：成本比= 0.36，95％CI = 0.11-1.12，P = 0.076）。结论 这些结果表明，包括抗阻运动、营养和心理社会计划在内的多因素干预可有效降低 LTCI 认证的发生率，从而节省 LTC 成本，尽管结果并不具有统计学意义。需要进行更严格的研究设计的进一步研究。
Objectives To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults. Methods Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1: 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model). Results The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio= 0.51, 95% confidence interval [CI]= 0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio= 0.36, 95% CI= 0.11-1.21, P= 0.099; LTC cost per unit follow-up period: cost ratio= 0.36, 95% CI= 0.11-1.12, P= 0.076). Conclusions These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.