Chronic kidney disease (CKD) is an independent risk factor for long-term care insurance (LTCI) need certification among older Japanese adults: A two-year prospective cohort study

Objective.Prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria is increasing globally and is complicated by patient movement between acute and long-term care facilities (LTCFs). In Asia, the contribution of LTCFs as a source of MDR GN infections is poorly described. We aimed to define the association between residence in LTCFs and MDR GN bloodstream infections (BSIs).Design.Secondary analysis of data from an observational cohort.Setting.Two tertiary referral hospitals in Singapore, including the 1,400-bed Tan Tock Seng Hospital and the 1,600-bed Singapore General Hospital.Participants.Adult patients with healthcare-onset (HCO) or hospital-onset (HO) GN BSI.Methods.Patients were identified from hospital databases using standard definitions. Risk factors for both MDR GN HCO and HO BSI were analyzed using a multivariable logistic regression model.Results.A total of 675 episodes of GN BSI occurred over a 31-month period. Residence in a LTCF was an independent risk factor for developing MDR GN BSI (odds ratio [OR], 5.1 [95% confidence interval (CI), 2.2–11.9]; P < .01) when antibiotics were not used within the preceding 30 days. This risk persisted beyond the first 48 hours of hospitalization (OR, 3.4 [95% CI, 1.3–9.0]; P = .01). Previous culture growing an MDR organism (OR, 1.8 [95% CI, 1.3–2.7]; P < .01), previous antibiotic use (OR, 1.8 [95% CI, 1.2–2.6]; P < .01), and intensive care unit stay (OR, 2.2 [95% CI, 1.2–3.9]; P = .01), increased the risk of MDR GN BSI.Conclusions.Residence in a LTCF is an independent risk factor for MDR GN BSI. Attempts to contain MDR GN bacteria in large Asian cities, where the proportion of the population that is elderly is projected to increase, should include infection prevention strategies that engage LTCFs.

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An Open-Label, Randomized, Multicenter, Controlled Study of Epoetin Alfa for the Treatment of Anemia of Chronic Kidney Disease in the Long Term Care Setting

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2010.09.009 ◽

2012 ◽

Vol 13 (3) ◽

pp. 244-248 ◽

Cited By ~ 8

Author(s):

Meenakshi Patel ◽

David G. Thimons ◽

Jaron L. Winston ◽

Wayne Langholff ◽

Tracy McGowan

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Care Setting ◽

Long Term Care ◽

Controlled Study ◽

Epoetin Alfa ◽

Open Label ◽

Term Care

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Range in systolic blood pressure and care-needs certification in long-term care insurance in community-dwelling older patients with chronic kidney disease

Journal of International Medical Research ◽

10.1177/0300060517721795 ◽

2017 ◽

Vol 46 (1) ◽

pp. 293-306 ◽

Cited By ~ 1

Author(s):

Taroh Himeno ◽

Tazuo Okuno ◽

Keisuke Watanabe ◽

Kumie Nakajima ◽

Osamu Iritani ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Older Patients ◽

Long Term Care ◽

Community Dwelling ◽

Care Needs ◽

Term Care ◽

Long Term Care Insurance ◽

Older Subjects

Objective Low systolic blood pressure (SBP) is associated with an increased risk for cardiovascular morbidity/mortality in older patients with chronic kidney disease (CKD). The present study evaluated the association between range in blood pressure and first care-needs certification in the Long-term Care Insurance (LTCI) system or death in community-dwelling older subjects with or without CKD. Methods CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 or dipstick proteinuria of + or greater. Our study was conducted in 1078 older subjects aged 65–94 years. Associations were estimated using the Cox proportional hazards model. Results During 5 years of follow-up, 135 first certifications and 53 deaths occurred. Among patients with CKD, moderate SBP (130–159 mmHg) was associated with a significantly lower adjusted risk of subsequent total certification (hazard ratio [HR] = 0.44) and subsequent certification owing to dementia (HR = 0.17) compared with SBP < 130 mmHg. These relationships were not observed in non-CKD subjects. Conclusion Lower SBP of <130 mmHg may predict a higher risk for subsequent first care-needs certification in LTCI, especially for dementia, in community-dwelling patients with CKD.

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Community social support and onset of dementia in older Japanese individuals: a multilevel analysis using the JAGES cohort data

BMJ Open ◽

10.1136/bmjopen-2020-044631 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044631

Author(s):

Yasuhiro Miyaguni ◽

Takahiro Tabuchi ◽

Jun Aida ◽

Masashige Saito ◽

Taishi Tsuji ◽

...

Keyword(s):

Social Support ◽

Cohort Study ◽

Emotional Support ◽

Prospective Cohort ◽

Long Term Care ◽

Community Level ◽

Term Care ◽

Incident Dementia ◽

Long Term Care Insurance

ObjectiveRecently, there has been an increase in the number of people with dementia. However, no study has examined the association between community-level social support and the onset of incident dementia using multilevel survival analysis.DesignA prospective cohort study.Participants and settingWe analysed data pertaining to 15 313 (7381 men and 7932 women) community-dwelling adults aged 65 years or older who had not accessed long-term care insurance and were living in Aichi Prefecture (seven municipalities) in Japan.Primary and secondary outcome measuresThe association between community-level social support and onset of incident dementia was examined using the Japan Gerontological Evaluation Study, a prospective cohort study introduced in Japan in 2003. Incident dementia was assessed using Long-term Care Insurance records spanning 3436 days from the baseline survey.ResultsDuring the 10-year follow-up, the onset of incident dementia occurred in 1776 adults. Among older people, a 1% increase in community-level social support (in the form of receiving emotional support) was associated with an approximately 4% reduction in the risk of developing dementia, regardless of socio-demographic variables and health conditions (HR=0.96; 95% CI=0.94 to 0.99).ConclusionsReceiving community-level social support in the form of emotional support is associated with a lower risk of developing incident dementia.

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