Municipal Governments' Long‐Term Care Prevention Efforts and Homebound Status of Older Adults: A Three‐Year Cohort Study in Japan

TL;DR

This study in Japan found that stronger municipal efforts to support daily living are linked to lower rates of older adults becoming homebound.

Contribution

The study provides empirical evidence linking municipal prevention efforts to reduced homebound status in older adults.

Findings

Higher DLSSDP scores in municipalities were associated with lower odds of homebound status in older adults.

The overall incidence of homebound status in 2022 was 2.8% among participants.

Variation in homebound status incidence ranged from 1.3% to 6.4% across 49 municipalities.

Abstract

Homebound status poses considerable risks for adverse health outcomes among older adults. To enhance the comprehensive care system, municipalities have implemented efforts aimed at long‐term care prevention. It is assumed that such efforts may help mitigate homeboundness. Therefore, this study examined the association between municipal long‐term care prevention efforts and homebound status among older adults.

This 3‐year cohort study utilized panel data between 2019 and 2022 from the Japan Gerontological Evaluation Study (JAGES), involving adults aged ≥ 65 years who were not homebound in 2019. As proxies for municipalities' prevention efforts, the Daily Living Support System Development Progress (DLSSDP) scores and Long‐term Care Prevention and Daily Living Support Progress (LCPDLSP) scores in 2019 were used as explanatory variables. The outcome was homebound status in 2022. Individual‐ and municipality‐level characteristics in 2019 were included as confounders. Multilevel logistic regression with multiple imputation was performed to estimate odds ratios for the association between each score and homebound status.

The study included 89 914 participants (female: 51.6%, mean age: 76.5 years). The overall incidence of homebound status in 2022 was 2.8%, with variations ranging from 1.3% to 6.4% across 49 municipalities. Compared with older adults in municipalities with high DLSSDP scores, those in municipalities with low scores had significantly higher odds of being homebound (odds ratio: 1.22; 95% confidence interval: 1.04–1.44). There were no significant differences in homebound odds across municipalities with varying LCPDLSP scores.

Living in municipalities with higher DLSSDP scores was associated with not being homebound.

Figures