How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database
How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database
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DOI：
10.1016/j.jamda.2022.11.021
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发表时间：
2023-02-22
影响因子：
7.6
通讯作者：
Matsumoto，Masatoshi
中科院分区：
文献类型：
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作者：
Miyamori，Daisuke;Yoshida，Shuhei;Matsumoto，Masatoshi
随着全球变暖，灾害变得更加频繁，世界各国都在寻求保护脆弱的老年人口的方法。虽然这些情况可能会增加老年人入住疗养院（NHA）的比率，但我们知道没有研究直接验证了这一假设。设计这是一项回顾性队列研究。设置和残疾人我们分析了日本3个县的长期护理保险（LTCI）用户的数据，这些县在2018年日本洪水中遭受了严重损失，这是日本历史上最大的洪水灾害。具体来说，我们从LTCI综合数据库中提取了NHA数据，包括受灾害影响和未受影响的个人。方法我们采用考克斯比例风险模型计算2018年日本洪水后6个月内NHA的多变量调整风险比（HR），并对潜在的混杂因素进行了调整。结果在调查期间使用LTCI服务的187，861人中，我们确定2156个（1.1%）为受灾害影响。受灾害影响的NHA的HR显著较高（与未受影响的）个体（调整后HR 3.23：95% CI 2.88 - 3.64），也高于年龄较大的HR（90-94岁vs 65-69岁：2.29，CI 1.93 - 2.70），认知障碍（重度损害vs正常：1.40，CI 1.25 ± 1.57）和身体功能（卧床vs独立：2.27，CI 1.83 ± 2.70）。根据我们的亚组分析，调整后的人力资源为受灾害影响的个人无法养活自己是6.00（CI 3.68 <$9.79），与2个变量之间的显着相互作用（P= .01）。结论和启示自然灾害增加老年人，特别是那些谁是无法养活自己的NHA的风险。卫生保健提供者和政策制定者应了解并准备应对这一新出现的风险因素。
ObjectivesAs disasters become more frequent because of global warming, countries across the world are seeking ways to protect vulnerable older populations. Although these conditions may increase nursing home admission (NHA) rates for older persons, we know of no studies that have directly tested this hypothesis.DesignThis was a retrospective cohort study.Setting and ParticipantsWe analyzed data from long-term care insurance (LTCI) users in 3 Japanese prefectures that incurred heavy damage from the 2018 Japan Floods, which is the largest recorded flooding disaster in national history. Specifically, we extracted NHA data from the LTCI comprehensive database, both for disaster-affected and unaffected individuals.MethodsWe employed the Cox proportional hazards model to calculate multivariate-adjusted hazard ratios (HRs) for NHAs within a 6-month period following the 2018 Japan Floods, with adjustments for potential confounding factors.ResultsOf the 187,861 individuals who used LTCI services during the investigated period, we identified 2156 (1.1%) as disaster affected. The HR for NHA was significantly higher for disaster-affected (vs unaffected) individuals (adjusted HR 3.23: 95% CI 2.88‒3.64), and also higher than the HRs for older age (90-94 years vs 65-69 years: 2.29, CI 1.93‒2.70), cognitive impairment (severe impairment vs normal: 1.40, CI 1.25‒1.57), and physical function (bedridden vs independent: 2.27, CI 1.83‒2.70). According to our subgroup analyses, the adjusted HR for disaster-affected individuals unable to feed themselves was 6.00 (CI 3.68‒9.79), with a significant interaction between the 2 variables (P= .01).Conclusions and ImplicationsNatural disasters increase the risk of NHA for older persons, especially those who are unable to feed themselves. Health care providers and policymakers should understand and prepare for this emerging risk factor.