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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  • YOKOYAMA Yuri
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • SEINO Satoshi
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • MITSUTAKE Seigo
    Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology
  • NISHI Mariko
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • MURAYAMA Hiroshi
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • NARITA Miki
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • ISHIZAKI Tatsuro
    Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology
  • NOFUJI Yu
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • KITAMURA Akihiko
    Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
  • SHINKAI Shoji
    Tokyo Metropolitan Institute of Gerontology

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Other Title
  • フレイル改善のための複合プログラムが要介護・死亡リスクと介護費に及ぼす影響：傾向スコアマッチングを用いた準実験的研究
  • フレイル カイゼン ノ タメ ノ フクゴウ プログラム ガ ヨウカイゴ ・ シボウ リスク ト カイゴヒ ニ オヨボス エイキョウ : ケイコウ スコアマッチング オ モチイタ ジュンジッケンテキ ケンキュウ

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Abstract

<p>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.</p><p>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).</p><p>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).</p><p>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.</p>

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