title: Day-care service use is a risk factor for long-term care placement in community-dwelling dependent elderly.
abstract: OBJECTIVE
  To identify predictors of long-term care placement and to examine the effect of day-care service use on long-term care placement over a 36-month follow-up period among community-dwelling dependent elderly.
  
  
  METHODS
  This study was a prospective cohort analysis of 1739 community-dwelling elderly and 1442 caregivers registered in the Nagoya Longitudinal Study for Frail Elderly. Data included the clients' demographic characteristics, basic activities of daily living, comorbidities, and use of home care services, including the day-care, visiting nurse, and home-help services, as well as caregivers' demographic characteristics and care burden. Analysis of long-term care placement over 36 month was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models.
  
  
  RESULTS
  Among the 1739 participants, 217 were institutionalized at long-term care facilities during the 36-month follow-up. Multivariate Cox regression models, adjusted for potential confounders, showed that day-care service use was significantly associated with an elevated risk for long-term care placement within the 36-month follow-up period. Participants using a day-care service two or more times/week had significantly higher relative hazard ratios than participants not using such a service.
  
  
  CONCLUSIONS
  The results highlight the need for effective measures to reduce the long-term care placement of day-care service users. Policy makers and practitioners must consider implementing multidimensional support programs to reduce the caregivers' willingness to consider long-term care placement.
authors: Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. kuzuya@med.nagoya-u.ac.jp
authors: Masafumi
authors: M
authors: Kuzuya
authors: Sachiko
authors: S
authors: Izawa
authors: Hiromi
authors: H
authors: Enoki
authors: Jun
authors: J
authors: Hasegawa
mesh_terms: D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D003631:Day Care, Medical / Q000706:statistics & numerical data*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D007564:Japan; D008134:Long-Term Care; D008297:Male; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors