Journal of Rehabilitation Medicine 51-4inkOmslag | Page 79

Nutrition intake status of elderly people in disaster settings
stores of texture-modified foods for vulnerable popula-
tion (8). Notably, an inadaptability to ingest emergency
food is not only seen in dysphagic patients, but may also
occur in elderly people without symptomatic dysphagia
who are able to consume regular food in ordinary set-
tings, but who are experiencing a latent decline in the
swallowing function (3, 4). To our knowledge, however,
no previous study has investigated and estimated the
potential risks associated with consuming emergency
foods in a community-dwelling elderly population.
Vulnerable groups should be assessed and considered
in public disaster preparedness planning (1). Studies
have shown that elderly people are less likely to store
items related to household preparedness (9). Comorbi-
dities, such as dementia or functional disorders, together
with insufficient social or familial support, restrict the
ability of these residents to stockpile sufficient amounts
of food for future disasters (5). Therefore, elderly popu-
lations are more likely to depend on public food supplies
during catastrophes. However, countermeasures for
these populations may be overlooked in the development
of disaster preparedness and response plans (8). This
underscores the critical importance of estimating the
population that would require specific preparedness or
assistance with nutritional intake in a disaster setting.
Thus, the present study aimed to estimate the com-
munity-dwelling elderly population with a dependence
on a specific form of nutritional intake and specific
food allocation, as well as those who would experience
difficulty solely when ingesting standard emergency
foods. The study therefore conducted a local district-
based total population survey of community-dwelling
elderly care recipients registered in the mandatory
long-term care insurance (LTCI) system.
MATERIAL AND METHODS
Ethical considerations
This study was performed in accordance with the Declaration
of Helsinki and was approved by the Ethics Committee of Keio
University (Tokyo, Japan; No. 20160211). The study was regis-
tered in the University Hospital Medical Information Network
Clinical Trials Registry (UMIN-CTR) public database (number
UMIN000023056).
Emergency foods
For this study, emergency foods were defined as storable foods,
including pre-gelatinized (alphanized) rice, canned porridge,
biscuits/crackers/cereals, protein/granola bars, canned side dis-
hes, trail mix/dried fruit, and ready-to-eat meals, in accordance
with government documents (10, 11).
LTCI system and care manager
The LTCI system was implemented in Japan as a mandatory
public healthcare insurance system. It aims to assist elderly indivi-
313
duals to lead more independent lives and to reduce the burden of
care on their families (12). All care recipients are registered at a
government-certified care managing office, where a licensed care
manager (CM) evaluates the health and medical status of the client
and formulates an individualized care plan (12). Approximately
17.7% of Japanese residents older than 65 years are certified by
this system and have access to care. This population is classified
into 7 levels according to the burden of care: Support Levels 1
and 2, and Care Need Levels (hereafter Care Levels) 1 through
5, with a higher number indicating a more intense level of care.
People with dementia are generally classified into a Care Level,
whereas those without dementia are classified into a Support
Level. For this study, the 7 care levels were re-grouped into 3
grades as follows: Low (Support Levels 1 and 2, Care Level 1),
Middle (Care Levels 2 and 3) and High (Care Levels 4 and 5).
Study design
This cross-sectional survey targeted community-dwelling
recipients of care under the LTCI system. It was conducted in
Shinjuku city within the Tokyo Metropolitan District in Japan,
which was selected because of its relatively lower rate of ageing
(percentage of people aged 65 years and older) within Japan
and its consequently fair external validity with respect to other
countries. All community-dwelling care recipients in this area
were registered at one of 77 local CM offices. The present investi-
gation was conducted through “Caremanet,” an organization of
the Shinjuku district liaison council CM office to which all local
CM offices belong. Thus, the target population comprised all
community-dwelling care recipients in Shinjuku city. No additio-
nal selection criteria were applied. Surveys were hand-delivered
to representatives from each CM office during a meeting on 25
September 2015 or were posted to offices whose representatives
were absent from the meeting. Responses were accepted via fax,
mail, or hand delivery until 16 October 2015. Data were analy-
sed in 2016 after receiving approval from the ethics committee.
In addition, assessors and their colleagues participated in a 3-h
lecture delivered by board-certified physiatrists that addressed
general knowledge about dysphagia, disaster preparedness from
the standpoint of dysphagia, and the explanation of the specific
questionnaire used in the study. Seventy-eight representatives
from 56 CM offices attended the lecture.
In the survey, respondents were asked about the number
of care recipients in each care grade who met the criteria for
dysphagia/nutrition states (A) through (E) as follows: (A) in-
travenous hyper-alimentation, (B) nasoenteric tube and gastric/
intestinal fistula, (C) texture-modified foods/thickened liquids,
(D) normal, but difficulties with ingestion of emergency foods,
and (E) no notable problems. To distinguish care recipients in
categories D and E, CMs used the Seirei dysphagia screening
questionnaire (Table SI 1 ), an easy screening questionnaire that
is considered highly reliable and valid (13, 14). The Seirei
questionnaire was originally established as a self-reported ques-
tionnaire comprising 15 different items. In this questionnaire,
the practical status is classified into severely impaired, mildly
impaired or intact for each item. CMs were asked to evaluate the
existence of signs of aspiration noted when they observed the
consumption of emergency foods or foods with similar attributes
by their care recipients. CMs were also allowed to discuss this
issue with care recipients or their families. Elderly individuals
with at least 1 severe symptom related to the consumption of
emergency foods were categorized into class D (13).
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2542
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J Rehabil Med 51, 2019