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Mortality differences in disabled older adults by place of care in Japan: nationwide 10-year results

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Abstract

This longitudinal study aimed to compare 1-year mortality between users of home- and community-based services (HCBS) and residential facilities (nursing homes, group homes, and geriatric apartments) among non-hospitalized frail older adults in Japan. Using three nationwide data sources, we conducted a nationwide pooled cohort study of 1-year follow-up among certified users of long-term care insurance (LTCI) aged  65 years and older from 2007 through 2016 to compare 1-year mortality using a logistic regression model. Overall, compared to HCBS users, mortality was higher in residents in nursing homes and geriatric apartments but lower in group home residents. While mortality gradually increased over time among those in residential facilities, it remained at a level similar to that of HCBS users. Since 2006, Japan’s public health policy has been to increase end-of-life care in residential facilities. Our results indicate that this policy resulted in an increase in mortality in residential facilities, possibly due to accommodation of more severely ill people there, or a shift in their focus from transferring dying residents to hospitals to preserve the dignity of residents.

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Acknowledgements

The Ministry of Health, Labour, and Welfare supported this study: Health and Labour Sciences Research Grant, Japan; Comprehensive Research on Aging and Health (H30-choju-ippan-007). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding

Funding was provided by Ministry of Health, Labour and Welfare (Grant No. H30-choju-ippan-007).

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Authors and Affiliations

  1. Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Tomoko Ito & Nanako Tamiya

  2. Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Tomoko Ito, Mikiya Sato, Xueying Jin, Taeko Watanabe & Nanako Tamiya

  3. Health Services Center, Human Resources Group, Sumitomo Heavy Industry, Ltd., Shinagawa, Tokyo, Japan

    Mikiya Sato

  4. National Institute of Public Health, Wako, Saitama, Japan

    Hideto Takahashi

  5. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Chihiro Omori & Yuta Taniguchi

  6. Faculty of Political Science and Economics, Waseda University, Shinjuku, Tokyo, Japan

    Haruko Noguchi

  7. National Center for Geriatrics and Gerontology, Obu, Aichi, Japan

    Xueying Jin

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  1. Tomoko Ito
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  2. Mikiya Sato
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  9. Nanako Tamiya
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Correspondence to Mikiya Sato.

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Appendix

Appendix

See Table 4.

Table 4 Services of long-term care insurance in Japan
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Ito, T., Sato, M., Takahashi, H. et al. Mortality differences in disabled older adults by place of care in Japan: nationwide 10-year results. J Public Health Pol 43, 542–559 (2022). https://doi.org/10.1057/s41271-022-00369-3

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