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.
The effects of assistive products in Korean long-term care insurance system for the beneficiary older adults
