Abstract
Objectives
Intermediate care for patients with dementia has important implications for aging
in place as long as possible. In Japan, geriatric intermediate care facilities provide
institutional rehabilitation services to patients under the public Long-Term Care
Insurance program and aim to discharge the patients to home from the hospital. The
aim of this study was to determine the association between dementia and discharge
destination of patients in geriatric intermediate care facilities in Japan.
Design
This study was conducted using a retrospective study design for data from 2007, 2010,
and 2013.
Setting
We used data from the Survey of Institutions and Establishments for Long-Term Care,
which is a nationally representative cross-sectional survey that assessed discharges
from geriatric intermediate care facilities in September.
Participants
There were 9992 discharged patients included in the analysis.
Measurements
Discharge destination was categorized as home, facility, hospital, or death. Primary
disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer),
F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic
analysis was used for discharge destination, with discharge to home as the reference
group.
Results
Of the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease.
Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were
admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%)
were discharged by death. Patients with dementia were more likely to be admitted to
hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25–1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64–2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13–1.89; P = .004) than discharged to home.
Conclusion
Intermediate care in residential settings might have limited effectiveness in discharging
patients with dementia to home. The national dementia plan should explore intermediate
care for dementia at other care settings rather than facilities.
Keywords
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Article info
Footnotes
The authors declare no conflicts of interest.
The present study was funded by JSPS KAKENHI through a Grant-in-Aid for Young Scientists (B), Grant 15K20796. The funding source had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Ministry of Health, Labor, and Welfare or the Japanese government.
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© 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
