title: Are there inequities in the assessment of dementia under Japan's LTC insurance system?
abstract: BACKGROUND
  Just two years after its inception, Japan's Long-term Care (LTC) insurance system is facing considerable criticism about whether or not it has developed a fair and appropriate way of allocating resources to the nation's disabled elderly population, especially those people with dementia.
  
  
  OBJECTIVE
  The present study has investigated: (i) the relation of the Government-Certified Disability Index (GCDI) of the LTC insurance system to characteristics of people with dementia and their family caregivers; and (ii) whether the GCDI scores adequately reflect needs of people with DAT (dementia of Alzheimer's type) and VD (vascular-type dementia).
  
  
  METHODS
  Subjects were assessed on their visits to outpatient clinics for their Activities of Daily Living (ADL), behavioural disturbances, MMSE, GCDI, service utilization and caregiver burden. Correlation analyses were conducted to examine the relationships among these variables, which were subsequently compared between the DAT and VD patients.
  
  
  CONCLUSIONS
  The GCDI was found to be associated with patients' ADLs and MMSE scores, and not with behavioural disturbances or caregiver burden. Compared to VD patients, people with DAT tended to have more behavioural disturbances but better ADL functioning. As a result, DAT patients were classified as 'less disabled' on their GCDI than VD patients, even though their caregivers felt as much burden as the caregivers of VD patients. These results show that the GCDI probably underestimates the impact of behaviour problems. Suggestions are made for a more balanced assessment of demented patients that is more consistent with their needs.
authors.affiliation: Research Unit for Nursing Caring Sciences and Psychology, National Institute for Longevity Sciences, Aichi, Japan. yarai@nils.go.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Arai
authors.forename: S H
authors.initials: SH
authors.lastname: Zarit
authors.forename: K
authors.initials: K
authors.lastname: Kumamoto
authors.forename: A
authors.initials: A
authors.lastname: Takeda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D003704:Dementia / Q000175:diagnosis* / Q000191:economics / Q000523:psychology / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D015276:Health Care Rationing / Q000379:methods / Q000592:standards*; D006301:Health Services Needs and Demand; D006801:Humans; D007353:Insurance, Long-Term Care / Q000592:standards*; D007564:Japan; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D011569:Psychiatric Status Rating Scales; D012920:Social Behavior Disorders / Q000175:diagnosis / Q000209:etiology