Aim: To determine the resident and facility characteristics associated with residents’ care-need level deterioration in long-term care welfare facilities in Japan. Methods: A nationally representative sample of 358 886 residents who lived in 3774 long-term care welfare facilities for at least 1 year from October 2012 was obtained from long-term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long-term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow-up to define the resident and facility characteristics associated with resident care-need level deteriorations (lost to follow-up: the majority were hospitalized residents or had died
were treated as deterioration in the including loss to follow-up model). Results: Adjusting for the covariates, at the resident level, older age and lower care-need level at baseline were more likely to show deterioration in the care-need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed-model facilities (partly private room settings) were less likely to experience care-need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care-need level deterioration only in the model including lost to follow-up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care-need level deterioration only in the model excluding lost to follow-up. Conclusions: The present study could help identify residents who are at risk of care-need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018
18: 758–766.

We evaluate a spillover effect of the Japanese public long-term care insurance (LTCI) as a policy to stimulate family caregivers’ labor force participation. Using nationally representative data from 1995 to 2013, we apply difference-in-difference propensity score matching to investigate the spillover effect in two periods: before and after the introduction of the LTCI in 2000 and before and after its major amendment in 2006. Our results show that the LTCI introduction has significant and positive spillover effects on family caregivers’ labor force participation and the effects vary by gender and age. In contrast, the LTCI amendment is found to have generally negative spillover effects on their labor force participation. We draw attention to these spillover effects, as expanding labor market supply to sustain the economy would be a priority for Japan and other rapidly aging countries in the coming decades.

目的 重度要介護高齢者の在宅日数は、地域別に算出することで地域包括ケアシステムの達成状況の評価指標となりうる。本研究の目的は、全国介護レセプトデータを用いて在宅日数を都道府県別に算出し、観察期間前後の打ち切り(以下、観察の打ち切り)を考慮して地域を比較する指標としての可能性を示すことである。方法 厚生労働省の承認を受けて8年間の全国介護レセプトデータを用いた。対象者は65歳以上で要介護4または5の認定を受け、要支援または要介護認定を受けていた期間に介護保険サービスを利用した者とした。観察期間における在宅日数が0日の対象者を在宅ゼロ群、在宅日数が1日以上の対象者を在宅群とし、在宅ゼロ群の人数の割合(以下、在宅ゼロ者割合)および在宅群の在宅日数平均値(以下、平均在宅日数)を算出した。次に在宅群を、打ち切りなし群、開始時打ち切り群、終了時打ち切り群、両側打ち切り群に分類して在宅日数を算出し、各群の割合を都道府県別に算出した。また、在宅ゼロ者割合と、平均在宅日数を都道府県別に算出し、両者の相関係数および散布図を示した。さらに、特定施設入居者生活介護等のサービス利用期間も在宅で生活した期間とした在宅日数(以下、介護保険在宅日数)を算出し、在宅日数との比較を行った。結果 対象地域は1,630市区町村(全市区町村の93.6%)で、対象者数は3,598,809人であった。在宅ゼロ者割合は37.8%、平均在宅日数は362.6日であった。打ち切りなし群、開始時打ち切り群、終了時打ち切り群、両側打ち切り群の人数(割合)はそれぞれ1,653,443人(45.9%)、240,136人(6.7%)、331,533人(9.2%)、15,013人(0.4%)、在宅日数平均値は247.8日、672.1日、610.6日、2570.9日であり、各群の人数の割合は都道府県により異なっていた。都道府県別の在宅ゼロ者割合の最大値と最小値は54.2%、30.3%で、平均在宅日数の最大値と最小値は475.5日、292.4日であった。在宅ゼロ者割合と平均在宅日数の相関係数は-0.55であった。在宅日数と介護保険在宅日数の差は、都道府県によって異なっていた。結論 在宅ゼロ者割合および平均在宅日数は、「観察の打ち切り」の影響を考慮する必要があるものの、両者を組み合わせることにより、地域の指標として利用可能であると考えられた。(著者抄録)

It is widely documented that psychological distress is negatively associated with social networks involvement. However, despite the theoretical postulations that social networks are crucial for alleviating psychological distress, no study has yet empirically confirmed the causality of this relationship. Thus, we used the random-effects generalized least squares method to investigate the effect of one- and two-year lagged values for involvement in social networks on psychological distress. Nine years of longitudinal data were extracted from a nationally representative survey in Japan ("The Longitudinal Survey of Middle-aged and Older Persons"). We utilized the Kessler 6 (K6) score to measure psychological distress among 15,242 respondents aged 50-59 years in the baseline year (2005), and stratified participants into three layers of social networks: inner (well-established friendship ties and participating in hobby activates), intermediary (neighborly ties), and outer (involvement in community activities). We found highly significant and negative associations between all three layers and K6 scores, with the strongest association being for the inner layer. We further observed that one-year lagged involvement in the inner and intermediary layers led to significantly lower K6 scores. However, the protective influences of social networks generally diminished over time. In addition, the protective influences of social network involvement on psychological distress were stronger for women than for men. Furthermore, involvement in social networks was especially important for improving mental health among people with psychological distress. These findings would be important for policymaking to prevent mental health deterioration among middle-aged adults in Japan. (C) 2017 Elsevier Ltd. All rights reserved.

Objective Previous studies conducted in Japan targeted only mothers who cared for children with disabilities, and lacked reference subjects, such as mothers of children without disabilities. The aim of this study was to examine the association between raising one or two children with a disability and maternal psychological distress compared to mothers of children without a disability, and to assess differences among partnered mothers living with grandparent(s), partnered mothers without grandparent(s), and single mothers. Methods This study utilized data from the Comprehensive Survey of Living Conditions (CSLC) in 2010. We merged the data of the children (aged six and over), mothers, and fathers. This study obtained 33,739 study subjects as a triad of a child (33,110 children without disabilities and 629 children with disabilities), mother, and father. The Japanese version of Kessler 6 (K6) was used to assess the psychological distress of mothers. Multivariate logistic regression was performed to assess the independent association of a child with a disability on maternal psychological distress after controlling for the basic characteristics of the children, mothers, and households. Results This study reported that raising one or two children with disabilities was significantly related to maternal psychological distress (odds ratio: 1.72 for one child, 2.85 for two children) compared to mothers of children without disability. After stratifying the analyses by family structure, significant associations remained among mothers in two-parent families but not for mothers in three-generation families and single mothers due to a small number of children with disabilities in these families. Conclusions This study reported the significant association between raising a child with a disability and maternal psychological distress in comparison to mothers of children without disabilities. Attention should be paid to not only single mothers, but also partnered mothers in two-parent families who have a child with a disability. It is important for health professionals to focus on the mental health of every mother of a child with a disability and to assess their needs for psychological support.

This paper examines the demand and supply of medical services for the elderly in the health services system characterized by per-month fixed copayment and selective capitation fee scheme for outpatients with chronic diseases. The results indicate that the beneficiary, in particular the household dependent, visits a physician more frequently because the actual copayment decreases for the household dependent, but is nearly the same for the head of the household. Physicians, however, provide more services to the beneficiary partly because of the lowered copayment and partly because of the capitation fee scheme, which they will select instead of the fee-for-service scheme only when capitation is more profitable than Fee-for-Service. As a result, physicians as well as the insured benefit from the health services system. (C) 2008 Elsevier B.V. All rights reserved.

本稿では、女性医師が病院と診療所のどちらを自身の勤務先として選択するかを、男性医師の選択と比較しつつ、世代別に分析する。使用するデータは、平成10年、12年、14年、16年度版「医師・歯科医師・薬剤師調査」の年齢別マクロデータおよび年齢階級別都道府県データである。マクロデータによると、病院勤務から離脱する年齢は女性のほうが低い。都道府県データを用いてパネルデータ分析による推定を行うと、50歳代以下の全ての世代で、女性医師は男性医師に比べてより病院から診療所へ勤務先を移していることがわかる。一方、診療所から病院への移動は男女ともほぼない。近年、病院勤務医が不足しているかもしれないということが問題となっているのは、経験を積んだ病院勤務医が診療所を開業するという以前からの傾向が、近年になってより増大してきたからであると言われている。本稿の結果から、女性医師数の増加がこの傾向に寄与していることが示唆される。