Journal of Rehabilitation Medicine 51-4inkOmslag | Page 80

314
S. Tashiro et al.
Table I. Community-dwelling proportion of care recipients in each care grade
Number by care/support need level a,b , n (%)
Support level 1
Support level 2
Care level 1
Care level 2
Care level 3
Care level 4
Care level 5
Total
Shinjuku city Japan (×10 3 ) Community-dwelling
proportion, % b Benchmark time for care,
min b
Dementia c , % ADL (FIM) d
2,507
1,866
2,349
1,904
1,387
1,595
1,414
13,022 887 (14.4)
852 (13.8)
1,205 (19.5)
1,076 (17.4)
804 (13.0)
741 (12.0)
610 (9.9)
6,175 100.0
100.0
94.5
88.6
71.1
54.7
46.1
81.0 25–32
32–50
32–50
50–70
70–90
90–110
> 110 –
–
103.8 ± 15.0
80.2± 16.4
73.0± 21.4
50.4± 20.0
24.6± 9.8
(19.3)
(14.3)
(18.0)
(14.6)
(10.7)
(12.2)
(10.9)
8.0
7.7
67.7
66.9
78.5
83.3
92.4
a
LTCI Shinjuku Monthly report 2015.10. Department of Welfare; Shinjuku-city, Principal Achievement of Long Term Care Insurance in Shinjuku-city, 2009-2015.
Tokyo (Japan): Shinjuku-city; 2016 (in Japanese) b LTCI National Monthly report 2015.10. Department of Geriatric Health, Division of Long Term Care Insurance
Service Plan; Ministry of Health, Labor and Welfare, Long Term Care Insurance Service Report (Preliminary), October, 2015. Tokyo (Japan); 2017 (in Japanese).
Available from: https://www.mhlw.go.jp/topics/0103/tp0329-1.html. C Lin et al., 2015 (23). d Okamura et al., 2004. (24).
FIM: functional independence measure; ADL: activities of daily living.
Setting
Shinjuku city is one of 23 special wards of the Tokyo Met-
ropolis. Although it is well known as the New Urban Center,
according to the Tokyo Metropolitan Government, it comprises
a wide variety of components, including highly urbanized
business, shopping malls and restaurants, high-end residential
areas, hotels, and downtown zones. Currently, Shinjuku has a
population of more than 330,000 residents and an ageing rate
of 19.5%, which is very similar to those of many developed
countries, including Sweden (19.9%), France (19.1%), and
Germany (21.2%) (15). Currently, 13,022 residents of Shinjuku
are certified in the LTCI system.
Statistical analysis
The χ 2 test was used to evaluate differences in the prevalence
of care levels between Shinjuku city and all of Japan. Cramer’s
coefficient of association was calculated to compare numbers of
elderly people classified in each care grade between Shinjuku
city and Japan using SPSS version 25 (IBM Corp., Armonk,
NY, USA).
RESULTS
LTCI-certified population in Shinjuku city and Japan
To clarify the characteristics of the study population,
we compared the demographics of the LTCI-certified
populations of Shinjuku city and Japan (Table I and
Table SII 1 ). Although Shinjuku had a relatively lower
proportion of elderly residents (19.5% vs 26.2% na-
tionally), it had a relatively higher proportion of resi-
dents certified recipients of care by the LTCI system
(19.6% vs 17.7% nationally). A small, but statistically
significant, difference in the distribution of care levels
was observed between the study area and all of Japan
(χ 2 (df 6) = 361.1 (p < 0.001); Cramer’s V = 0.0073).
Dysphagia among community-dwelling elderly
residents requiring care
Survey responses were received from 22 of 77 CM of-
fices (28.6%). Representatives of all those 22 offices
had attended the preparatory lecture. Data about special
needs regarding food intake were acquired from 1,271
of the 10,790 total care recipients (11.8%) registered in
Shinjuku (Table II). Of the community-dwelling elderly
care recipients who participated in the study, 34.6% were
reported to have some level of swallowing difficulty
(A+B+C+D). Of these, 23.1% of community-dwelling
elderly care recipients were found to have dysphagia
(A+B+C), whereas 11.5% were a unique population
identified for the first time by this study as people at
potential risk of difficulty with ingesting emergency
foods, despite being classified as without dysphagia in
ordinary settings (D). After excluding the population not
dependent on oral ingestion (A+B), 19.7% of the study
population was considered at risk of aspiration when con-
suming regularly distributed emergency foods (C+D).
Table II. Profiles of swallowing problems among community-dwelling older people in need of care
LTCI grade Total Low grades
(SL1–2 and CL1) Middle grades
(CL2–3) High grades
(CL4–5)
Eligible individuals objected, n
(A) Intravenous hyper-alimentation, n (%)
(B) Nasoenteric tube and gastric/intestinal fistula, n (%)
(C) Texture-modified foods/thickened liquids, n (%)
(D) Difficulty with ingestion of emergency food, n (%)
(E) No notable problem, n (%)
Fraction population of LTCI in Shinjuku city
Estimated dysphagia population (A+B+C), n
Estimated population at risk of aspiration at disaster (C+D), n (%)
Estimated population with swallowing problem (A+B+C+D), n (%) 1,271
98 (7.7)
91 (7.2)
105 (8.3)
146 (11.5)
831 (65.4)
13,022
3,012 (23.1)
2,572 (19.7)
4,508 (34.6) 446
18 (4.0)
15 (3.4)
21 (4.7)
17 (3.8)
375 (84.1)
6,722
814 (12.1)
573 (8.5)
1,070 (15.9) 519
32 (6.2)
30 (5.8)
34 (6.6)
27 (5.2)
396 (76.3)
3,291
609 (18.5)
387 (11.8)
780 (23.7) 306
48 (15.7)
46 (15.0)
50 (16.3)
102 (33.3)
60 (19.6)
3,009
1,416 (47.1)
1,495 (49.7)
2,419 (80.4)
LTCT: long-term care insurance; SL: support level; CL: care need level.
www.medicaljournals.se/jrm