The life expectancy of Japanese people has dramatically increased in recent years. Thus, it has led to a concurrent increase in the number of frail elderly who need day care. In Japan, the social insurance system is called the long-term care insurance (LTCI) system, referred to as Kaigo Hoken, and it has been in effect for individuals aged 65 or older since April 1, 2000. In April 2006, the LTCI system was modified to include new preventive benefits.
The LTCI system allows those in need of long-term care due to a disease caused by advancing age or for other reasons to receive services in a comprehensive and uniform way. The belief is that frail people can lead largely independent lives. Programs are offered for those who remain at home, those who are active in the community, and those who live in institutions.
The users of these services are people at Support Level 1 or 2 (they do not need continuous care but need some support in daily life, such as assistance in dressing themselves) and people with Care Need Levels 1 through 5 (they need continuous care because they are bedridden, have dementia, or need other assistance). These levels are based on original criteria from the Japanese Ministry of Health, Labor and Welfare. When someone wants to use the service of the long-term care insurance, a care manager first prepares a care plan, which is a combination of several types of services according to the person’s need for care or support.
Community-based day-care service in Japan, serving approximately 400,000 people, is one of the major services used in LTCI programs. In Japan, there are 6,380 day-care centers, which provide a number of services, including transportation, meals, rehabilitation programs, recreational activities, consultation, advice for daily life, and monitoring health status. The frail elderly use the day-care service one to three times a week between Monday and Friday in most centers.
Research to Aid Aging
Research studies to evaluate interventions implemented with frail elderly who use day-care service were initiated in 2007 by Kiyoji Tanaka’s laboratory at the University of Tsukuba. Our research focuses on prevention of disability and the epidemiology of frailty. In particular, our research focuses on the effects of a community-based preventive care program in preventing decline of physical function among community-living frail elderly. Our research shows that balance ability and lower-extremity strength tests can be used together to effectively identify or monitor any change in the physical characteristics of community-dwelling frail people who are day-care service users.
Our results, based on 150 day-care service participants aged 65 to 101, show that many day-care service users were unable to perform the one-legged stance (28.9%), tandem stance (32.5%), functional reach (19.3%), tandem walk (61.4%), alternate step (53.0%), and 5 chair sit-to-stand (31.3%) tests. Thus, the tests for balance and lower-extremity strength seem to be useful in monitoring early decline in physical function. However, all participants were able to perform the grip strength, timed up-and-go, and usual gait speed tests.
In addition, our study showed that the observed thresholds for discriminating between day-care service users and well-functioning older individuals (nondisabled individuals) were as follows: timed up-and-go test, 12.7 s; usual gait speed, 0.79 m/s; and grip strength, 16.3 kg. In other words, those individuals who perform poorer than these levels are at higher risk for frailty, and therefore, these threshold values can be used to identify older people who require immediate intervention in order to prevent long-term care.
Because exercise can prevent further declines in physical function, effective programs for preventing and/or slowing the decline in physical function are greatly needed.