title: Relationship between home care service use and changes in the care needs level of Japanese elderly.
abstract: BACKGROUND
  With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.
  
  
  METHODS
  The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.
  
  
  RESULTS
  In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.
  
  
  CONCLUSIONS
  There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.
authors.affiliation: Department of Health Services Research, Doctoral Program in Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan. goheik@saitama-med.ac.jp
authors.forename: Gohei
authors.initials: G
authors.lastname: Kato
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.forename: Masayo
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Mikiya
authors.initials: M
authors.lastname: Sato
authors.forename: Hideto
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment