Abstract
Background
In Asia, where autonomous decision-making is not well accepted, little is known about whether and how individuals’ preferences are considered when deciding where they receive care. This study examined the longitudinal association of aging-in-place preference when bedridden with institutionalization among Japanese older adults.
Methods
We analyzed nationally representative data of 1,290 community-dwelling older adults aged 70 and above, applying the multiple imputation method. Baseline data were collected in 1999, shortly before the long-term care insurance system was introduced. The outcome was measured as self- or proxy-reported years of institutionalization over seven years. The explanatory variable was the aging-in-place preference. Participants were asked about their desired place of care (facility, home, or other) when bedridden. Covariates were sociodemographic and health-related factors. We used Cox proportional hazards models and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the association of aging-in-place preference when bedridden with institutionalization.
Results
Seventy-eight respondents (6.0%) were institutionalized during the follow-up period. Compared to individuals preferring to reside in long-term care facilities when bedridden (48.7%), those preferring to stay in their homes (39.6%) were less likely to be institutionalized, even after adjusting for relevant covariates (HR = 0.46, 95% CI 0.27–0.79 for model 1 including residential status; HR = 0.45, 95% CI 0.27–0.76 for model 2 including marital status and co-resident children).
Conclusions
Our findings suggest that individuals’ aging-in-place preferences are considered under the long-term care insurance system. Individuals’ preferences should be shared by families and clinicians when deciding the place of care.
Associations Of Physical Activity And Sedentary Behavior With The Onset Of Long-term Care Need In Community-dwelling Independent Japanese Older Adults: The Tsuru Study
