Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Equity of access to long-term care among the Korean elderly

The aim of the current study is to examine the extent to which equity in the utilization of longterm care services has been achieved in the Republic of Korea (hereafter Korea), based on the Aday—Andersen Access Framework that takes into consideration a series of variables hypothesized as predictive of utilization. The current study used cross-sectional survey data collected and conducted by the Korea Labor Institute (KLI) between August 1 to December 22, 2006. The sample for this study was 5544 persons who are older than 60 years. The study was extracted from a larger nationally representative cross-sectional survey of 10,255 individuals. The stratified cluster sampling technique was used to draw the survey respondents. A self-administered questionnaire was used to collect the data from the sample. Descriptive and logistic regression analysis was performed examining the relationship between the dependent variable and the independent variables and the relative importance of factors. The results indicate that a universal health insurance system has not yielded a fully equitable distribution of services. The limitation of benefit coverage as well as disparities in consumer cost-sharing and associated patterns of utilization across plans high out-of-pocket payment can be a barrier to health care utilization, which results in inequity and differential long-term care utilization between sub-groups of older adults. Health policy reforms in Korea must continue to concentrate on expanding insurance coverage, reducing the inequities reflected in disparities in consumer cost-sharing and associated patterns of utilization across plans, and establishing a financially separate insurance system for poor older adults. The behavioral responses of physicians to the method of reimbursement, and the subsequent impact on overall rates of utilization and expenditures need to be more fully understood. In addition, further research is needed to identify the nonfinancial barriers that persist for certain demographic subgroups, i.e., those 70 and older, men, lacking social network members, those who have four or more family members, and those who have no schooling.

The research of the community-home elderly long-term care service system

With the rapid development of the aging of the population, the demand of long-term care services in the elderly is growing. Because of family miniaturization, core, and currently limited social accumulation are difficult to meet the demand of the elderly in long-term care.Community provides the elderly long-term care services, and provides the elderly all kinds of household helping services. They just make up for the inadequacy of the family and society.And how to make the community elderly long-term care services become more suitable for the needs of the elderly at home, provide better service for the elderly, are our current problems to be solved.

Analysis on Long-Term Care and Influencing Factors of Empty-Nest Differently Abled Elderly People in China —Based on the Data from the Chinese Longitudinal Healthy Longevity Survey

Purpose: This study aimed to understand the actual needs of empty-nest differently abled elderly people and analyze their long-term care status including the factors affecting choice of care mode so adequate resources can be allocated to meet their healthcare needs. Methods: An empty-nest group was compared with a non-empty-nest group based on data from the 2014 Chinese Longitudinal Healthy Longevity Survey. Individual characteristics, family characteristics, and sociological factors were considered as independent variables, and long-term care model was the dependent variable in the three binary logistic regression method. Results: Age, gender, marriage, and disability were the most important factors influencing the choice of long-term care mode, including the willingness of the differently abled elderly. Family care can no longer meet the needs of the severely disabled elderly. Long-term care for such elderly people should be undertaken by professional and specialized social institutions. Conclusion: Multi-level services should be provided according to the elderly peoples’ needs, and the skill and expertise of professional personnel of care institutions should be strengthened. The government should deploy fund-raising initiatives, actively use the power of non-governmental organizations, and strive to resolve the financial issues faced by the empty-nested elderly people with disability.

Path Exploration for Long-term Care of Rural Disabled Elderly: A Case Study of G Town in South Shaanxi

Field survey of G Town in South Shaanxi indicates that current situations and existing problems of rural disabled elderly. According to these situations and problems,this paper analyzes difficulties in long-term care of rural disabled elderly. From the perspective of welfare pluralism,it comes up with development paths for long-term care of rural disabled elderly with joint participation of government,communities,non-profit organizations on the basis of the family endowment.

Comparison of research hotspots and trends in long-term care for the elderly between China and Australia: a bibliometric analysis

Objective:To explore the current status and development of long-term care(LTC)research in terms of publications in China and Australia,to identify the major contributing authors and institutions,and to compare the research hotspots and trends between China and Australia in order to encourage informed collaborations and work in future.Methods:We collected bibliometric data on the LTC of the elderly in China and Australia from 2009 to 2020 using Chinese National Knowledge Infrastructure(CNKI)and Web of Science(WOS).Cite Space software was used to analyze co-authorships,co-institutions,and co-keywords.Results:A total of 826 ar ticles in Chinese and 393 in English were included for analysis.The total number of publications showed an upward trend in both countries.The top 10 productive researchers and institutions in China and Australia were identified,and their collaboration network was revealed.Then,the knowledge maps of cooccurring keywords,respectively,showed the hotspots of"LTC insurance,disabled elderly,combination of medical and health care,nursing home"and"nursing home,dementia,quality of life,intervention"in China and Australia.Strong citation burst keywords illustrated the emerging trends of"combination of medical and health care,healthy aging"in China and"polypharmacy,prevention"in Australia.Conclusions:This article provided an insight into LTC of the elderly in China and Australia,and research in this field is developing rapidly and is being increasingly valued.The findings will be useful for future researchers to facilitate collaboration,identify new topics,and suppor t urgently needed research of LTC in China.

The Effect and Effectiveness Evaluation of Sit-up Training on Elderly Bedridden Patients with Severe Pneumonia

The objective of the study was to access the effect and the effectiveness of sit-up training on elderly bedridden patients with severe pneumonia.A total of 150 elderly bedridden patients diagnosed with severe pneumonia were recruited for this study.They were divided equally into the observation group and control group,that is,75 cases in each group.All patients were selected from January 2016 to April 2018.On this basis,both groups were treated with the same routine nursing care except with the addition of 30–60 min situp trainings twice daily for the control group under supervision.The clinical hospitalization outcomes,length of hospital stay,and patient care satisfaction of the two groups were compared.The clinical hospitalization outcomes,length of hospital stay,and patient satisfaction of the observation group were found to be superior to the control group,and the difference was significant.In bedridden elderly patients with severe pneumonia,sit-up training had positive effects and beneficial in improving the clinical outcomes and recovery rate.

Long-term care policy simulation of disabled elderly

With the accelerating process of population aging in our country, the physical function of the elderly will decline, the possibility of suffering from acute and chronic diseases will increase, and the occurrence of disability will become more common and normal. The potential demand for elderly care is rapidly increasing. With the growth, the care of the disabled elderly has become increasingly acute. At the same time, due to the intensification of family miniaturization and population migration, the traditional family-based long-term care has been difficult to sustain. How to incorporate long-term care into our social security system as soon as possible has become the focus of the whole society. The thesis through the combination of public policy simulation methods and the research data, the long-term care insurance system implemented at the beginning of 2018 in Shanghai is a policy blueprint. It uses statistical software SPSS, MATLAB, etc. to achieve data collation, analysis and prediction, and at the same time integrates the pilot of the long-term care insurance system. The implementation of policies in cities such as Qingdao and Nantong has been simulated. Finally, on the basis of simulation results, suggestions have been made for the future development of China＇s long-term care insurance system.

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。

Heart valve disease in elderly Chinese population： effect of advanced age and comorbidities on treatment decision-making and outcomes

Background A considerable proportion of elderly patients with symptomatic severe heart valve disease are treated conservatively de- spite clear indications for surgical intervention. However, little is known about how advanced age and comorbidities affect treatment deci-sion-making and therapeutic outcomes. Methods Patients （n = 234, mean age： 78.5 ± 3.7 years） with symptomatic severe heart valve dis- ease hospitalized in our center were included. One hundred and fifty-one patients （65%） were treated surgically （surgical group） and 83 （35%） were treated conservatively （conservative group）. Factors that affected therapeutic decision-making and treatment outcomes were investi- gated and long-term survival was explored. Results Isolated aortic valve disease, female sex, chronic renal insufficiency, aged _〉 80 years, pneumonia, and emergent status were independent factors associated with therapeutic decision-making. In-hospital mortality for the surgical group was 5.3% （8/151）. Three patients （3.6%） in the conservative group died during initial hospitalization. Low cardiac output syndrome and chronic renal insufficiency were identified as predictors of in-hospital mortality in the surgical group. Conservative treatment was identi- fied as the single risk factor for late death in the entire study population. The surgical group had better 5-year （77.2% vs. 45.4%, P 〈 0.0001） and 10-year （34.5% vs. 8.9%, P 〈 0.0001） survival rates than the conservative group, even when adjusted by propensity score-matched analysis. Conclusions Advanced age and geriatric comorbidities profoundly affect treatment decision-making for severe heart valve disease. Valve surgery in the elderly was not only safe but was also associated with good long-term survival while conservative treatment was unfavorable for patients with symptomatic severe valve disease.

Volunteers as caregivers for elderly with chronic diseases:An assessment of demand and cause of demand

Objective:We sought to examine the demand of volunteers on long-term care of elderly patients with chronic diseases.Further,we evaluated patients'reasons to want long-term care volunteers as well as socioeconomic factors affecting these needs.Methods:Questionnaires were distributed to 516 elderly with chronic diseases from nursing homes,hospitals,and elderly living with relatives.Patient questions dealt with basic socioeconomic questions,their reasons to want care volunteers,and the nature of chronic disease,and their motivation to volunteer and which sorts of activities they perform while volunteering.Results:73.4%of the elderly patients with chronic diseases desired to have volunteers for long-term care.The most desired services were care visits,transportation,and leisure/recreation activities.The number of chronic diseases they had,their marital status,education level,and social support system were all statistically important.Conclusion:The data presented here suggest that the government should actively advocate for volunteer service for elderly with chronic diseases.Additional support is needed in terms of financial support,incentive measures,professional training for volunteers,and supervision of volunteers.Such developments are needed to improve volunteer service standards.

Healthcare Needs of the Elderly People over 85 Years Living Alone on the Island Area in Japan: A Descriptive Study

Background: Japan has the highest aging people accounting 33.8 million with the rate of 26.7% in 2015. Although, public long-term care insurance services support people age 40 years and above, most of the users are 85 years and over due to their more vulnerability for getting sick. This study describes the physical, mental and social status of the elderly people aged 85 years and over, who were living alone at home. Method: A cross-sectional study was conducted between November 2016 and March 2017 in the island of Kure city, Hiroshima, Japan. A structured questionnaire and scales were used for data collection and documentation of physical measurements. Descriptive analysis was used. Result: A total of 190 subjects were participated, and the data were analyzed. The age range of the subjects was 85 to 98 years, and 68.4% of them were 85 to 89 years old. Male and female ratio was 21.6% vs 78.4%. Subjects of 17.4% continued their occupation at the time of the study period and most of them involved in agricultural work (93.9%). A certain percentage of the subjects had abnormal physical, mental and social difficulties and need additional support from family, friends, relatives, and community. Conclusion: Early detection and intervention such as disease management, nutritional support, and human support are required. The findings suggested policy makers to predict the burden and provide necessary care for these elderly people. It is necessary to aware family, friends, relatives, community and government supporting staff to provide information on correct recognition and usages of long-term care insurance services for these elder people.

A phase Ⅳ study of homoharringtonine, cytarabine, aclacinomycin and G-CSF(HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia(AML) patients. Methods · Forty-one patients with AML(aged 55-71 years) were randomly divided into two groups(Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival(RFS). Results · A total of 29 patients(70.7%) achieved complete remission(CR). The estimated 2-year overall survival(OS) was 66.8% in Group HCAG and 75.4% in Group IA(P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA(P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

Potential Legal Issues and Care Implications during Care-Prevention Gymnastic Exercises for the Elderly Using Pepper in Long Term Health Care Facilities

In Japan, the shortage of personnel is a problem in long-term care nursing and rehabilitative care prevention. Nevertheless, Japan has taken measures to compensate for these shortages by promoting medical and nursing care activities using robotic technologies, and employing human resources from overseas. The purpose of this study was to determine potential legal issues and subsequent implications for care during prevention gymnastic exercises for the elderly using Pepper in long-term health facilities. The application program of Care-Prevention Gymnastics Exercises for Pepper (Pepper with CPGE) was made by the Xing Company Japan. Currently, care workers become intermediaries for the safe use of Pepper with CPGE. However, it was realized that some legal issues may arise if Pepper with CPGE alone will carry out these preventive care programs for the elderly without the presence of care workers as intermediaries. In this situation, using Pepper with CPGE alone to conduct care prevention gymnastics will require safety measures to prevent these possible practice issues and anticipate implications for care. In this regard, determining detailed target levels of rehabilitation exercise demands and environmental setting safety become essential factors. The use of humanoid robots in healthcare is expected to influence more practice protocols in contemporary and futurist rehabilitative human care. The identification of possible safety issues in performance and environmental situations, and implications for care are critical to ensure safe and valuable rehabilitative health care practices for the elderly population.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

The Relationship with Previous Use of Community-Based Services and Informal Caregiver Support and Elderly and Informal Caregivers’ Views of Living Arrangement: Analysis of Official Statistics from 2004 to 2014

Background and Objectives: Views on living arrangement from elderly and informal caregivers are crucial to “ageing in place”. They might be related to the experience in the use of elderly care services, which remains inconclusive in previous literature. This study aimed to explore the association of previous experience in formal and informal long-term care services with views of both elderly and their informal caregivers on living arrangement. Research Design and Methods: This study adopted a cross-sectional design. Assessment records of Minimum Data Set-Home Care for community-dwelling elderly who were eligible for subsidized long-term care services in Hong Kong from 2004 to 2014 were made available. Multivariate logistic regression was applied to examine associations between both views on elder’s living arrangement from the elderly, caregivers and their previous informal caregiver support, and experience in formal care services. Results: 82,306 dyads of elderly and informal caregivers were included in the analysis. The elderly with previous use of home and community-based services (OR = 0.84, 95% CI 0.80 - 0.88) and informal caregivers (OR = 0.78, 95% CI 0.76 - 0.81) believed that the elderly should live away from home. Temporal trends of fewer elderly and caregivers supporting the idea of living away from home were also observed. Discussion and Implications: The results highlighted the importance of informal caregiver’s support and previous utilization of formal home and community-based services. It was concluded that resources and information of community-based care have a significant association with views on living at home also proper support services and training of care for the elderly should be made available to informal caregivers to reduce their burden.

Fitness Age Score and the Risk of Long-Term Care Insurance Certification—The Kyoto-Kameoka Longitudinal Study

Long-Term Care Insurance System has been introduced to provide appropriate care for the elderly who needs nursing care in Japan. Physical function is one of most important function for the elderly to live independently. A previous study had established a Fitness Age Score (FAS) based on a theory for biomarker of aging. This study clarified whether the FAS could be used to predict the need for certification of long-term care (CLTC) in independent elderly people. We included 939 independent, community-dwelling-elderly (average age, 74.4 years) whose physical function was measured and for whom the CLTC was tracked for 24 months. The FAS comprised five physical fitness items: Walking time, grip strength, one-leg standing, vertical jump, and functional reach test. Based on the FAS, we calculated the odds ratio (OR) for the CLTC. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) was used for further analysis. We also used the Youden Index (YI), minimum distance method (MD), and two-graph ROC method (TG) to calculate cutoff values (CVs) for screening. We divided subjects into the low and high physical fitness group with CVs. We developed cumulative CLTC curves using the Kaplan-Meier method. Sixteen people could not be tracked for the full 24 months. The measurement of FAS was completed for 798 people, of whom 28 became CLTC. The measurement of FAS was not completed for 125 people, of whom 21 became CLTC. The CLTC OR for people with incomplete FAS was 5.553. The AUC was 0.72 (p < 0.001). The CVs for the FAS were -0.29 for YI (sensitivity, 92.9% and specificity, 40.4%), -1.23 for MD (57.1% and 73.4%), and -0.81 for TG (60.7% and 60.9%). The cumulative CLTC curves according to CVs all showed significant differences (p = 0.000 - 0.020). In conclusion, the FAS can be used to predict CLTC.

An Elderly Patient with Advanced Lung Cancer Achieved Long-Term Survival Using Chinese Medicine:An Alternative Treatment Strategy for Cancer Patients Aged 80 or Older without A Tissue Confirmed Diagnosis

Lung cancer is the leading cause of cancerrelated mortality in China.（1＇2） Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.

限制热卡饮食对老年卧床2型糖尿病患者的影响

目的观察限制热卡饮食对老年2型糖尿病卧床患者胰岛功能及营养状况的影响。方法对15例老年科长期卧床T2DM患者在原供给热卡30kcal/(kg·d)基础上,予以减少热卡至20kcal/(kg·d),比较限制热卡前后不同时间患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素、空腹C肽、胰岛素用量、白蛋白(ALB)及血红蛋白(HGB)水平。结果限制热卡饮食后第5周患者FPG、HbA1c、空腹胰岛素及空腹C肽水平较前明显下降,胰岛素用量减少,而白蛋白及HGB均较前略升高。结论限制热卡饮食可降低老年卧床2型糖尿病患者血糖水平,改善患者胰岛素抵抗(insulin resistance,IR),而对患者营养状况无明显不良影响。

Correlations between Motor Ability with Gait Speed and Cognitive Functions in Rehabilitation Users

Purpose: To compare and examine motor and cognitive functions in people who require support, and in healthy elders. Method: The variables of age, BMI, educational background, blood pressure, grip strength, knee extension, gait speed, MMSE, and subjective health feeling for 36 rehabilitation users and 22 healthy elders were assessed. We compared and examined motor and cognitive functions in rehabilitation users who need support and healthy elders. Results: The percentage of MMSE scores with 27 points or higher and that of subjective health feeling with 3 points or higher were significantly higher in healthy elders than in rehabilitation users. Systolic and diastolic blood pressure were significantly higher in rehabilitation users than in healthy elders. Gait speed and MMSE scores were significantly higher in healthy elders than rehabilitation users. Conclusion: Gait speed could be used for physical fitness in elders. Gait speed was the best physical fitness measurement for elders. Gait speed of rehabilitation users was strongly related to MMSE scores. Gait speed could be a determinant of MMSE scores.