Evaluation of preventive care for swallowing difficulty through policy changes in Japanese long-term care insurance: analysis of a nationwide claims dataset for long-term care insurance.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Insurance, Long-Term Care* ; Deglutition Disorders*; Humans ; Aged ; Long-Term Care ; Deglutition ; East Asian People ; Policy ; Japan/epidemiology

Background: Swallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services.
Methods: The nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined.
Results: Between 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users' disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014.
Conclusions: Due to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.
(© 2023. BioMed Central Ltd., part of Springer Nature.)

Ortega O, Martin A, Clave P. Diagnosis and management of Oropharyngeal Dysphagia among older persons, state of the art. J Am Med Dir Assoc. 2017;18:576–82. (PMID: 10.1016/j.jamda.2017.02.01528412164)
World Health Organization. International statistical classification of diseases and related health problems (11th ed.). (2022) https://icd.who.int/ct11/icd11_mms/en/release . Accessed 02 October 2022.
World Health Organization. International Classification of Functioning, Disability and Health. (2007). https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health . Accessed 02 October 2022.
Hägglund P, Koistinen S, Olai L, Ståhlnacke K, Wester P, Levring Jäghagen E. Older people with swallowing dysfunction and poor oral health are at greater risk of early death. Community Dent Oral Epidemiol. 2019;47:494–501. (PMID: 10.1111/cdoe.12491314078296899490)
Lindroos EK, Saarela RKT, Suominen MH, Muurinen S, Soini H, Kautiainen H, et al. Burden of oral symptoms and its Associations with Nutrition, Well-Being, and survival among nursing home residents. J Am Med Dir Assoc. 2019;20:537–43. (PMID: 10.1016/j.jamda.2018.10.02530541688)
Namasivayam-MacDonald AM, Shune SE. The Burden of Dysphagia on Family Caregivers of the Elderly: a systematic review. Geriatr (Basel). 2018;3:30. (PMID: 10.3390/geriatrics3020030)
Mori H, Naito M, Nakane A, Tohara H. Caregivers’ perspectives on the slight recovery of oral intake of Home-Dwelling Patients Living with a percutaneous endoscopic gastrostomy tube: a qualitative study using Focus Group interviews. Nutr Clin Pract. 2019;34:272–9. (PMID: 10.1002/ncp.1025330741499)
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780–91. (PMID: 10.1111/j.1532-5415.2007.01156.x174932012409147)
Baijens LW, Clave P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–28. (PMID: 10.2147/CIA.S107750277850025063605)
Park YH, Bang HL, Han HR, Chang HK. Dysphagia screening measures for use in nursing homes: a systematic review. J Korean Acad Nurs. 2015;45:1–13. (PMID: 10.4040/jkan.2015.45.1.125743729)
Streicher M, Wirth R, Schindler K, Sieber CC, Hiesmayr M, Volkert D. Dysphagia in nursing Homes-Results from the NutritionDay Project. J Am Med Dir Assoc. 2018;19:141–7e2. (PMID: 10.1016/j.jamda.2017.08.01529030310)
Hollaar VRY, van der Putten GJ, van der Maarel-Wierink CD, Bronkhorst EM, de Swart BJM, de Baat C, et al. Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: a retrospective, cross-sectional study. Geriatr Nurs. 2017;38:437–41. (PMID: 10.1016/j.gerinurse.2017.02.00728347558)
Lin LC, Wu SC, Chen HS, Wang TG, Chen MY. Prevalence of impaired swallowing in institutionalized older people in Taiwan. J Am Geriatr Soc. 2002;50:1118–23. (PMID: 10.1046/j.1532-5415.2002.50270.x12110075)
Park YH, Han HR, Oh BM, Lee J, Park JA, Yu SJ, et al. Prevalence and associated factors of dysphagia in nursing home residents. Geriatr Nurs. 2013;34:212–7. (PMID: 10.1016/j.gerinurse.2013.02.01423528180)
Sugiyama M, Takada K, Shinde M, Matsumoto N, Tanaka K, Kiriya Y, et al. National survey of the prevalence of swallowing difficulty and tube feeding use as well as implementation of swallowing evaluation in long-term care settings in Japan. Geriatr Gerontol Int. 2014;14:577–81. (PMID: 10.1111/ggi.1213724020472)
Clave P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12:259–70. (PMID: 10.1038/nrgastro.2015.4925850008)
Ogawa S, Hosoi T, Akishita M, Igarashi A. Malnutrition-related Health Care cost in Japan: an analysis of Health Insurance Claims Data. Asia Pac J Public Health. 2019;31:594–602. (PMID: 10.1177/101053951987494631537120)
Elia M, Stratton RJ. Calculating the cost of disease-related malnutrition in the UK in 2007 (public expenditure only) in: Combating Malnutrition: Recommendations For Action. (2009) http://www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf . Accessed 08 August 2023.
Lieu PK, Chong MS, Seshadri R. The impact of swallowing disorders in the elderly. Ann Acad Med Singapore. 2001;30:148–54. (PMID: 11379412)
Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res. 2019;31:799–805. (PMID: 10.1007/s40520-019-01128-330671866)
Kishimoto N, Stegaroiu R, Shibata S, Otsuka H, Ohuchi A. Income from nutrition and oral health management among long-term care insurance facilities in Niigata Prefecture, Japan. Gerodontology. 2019;36:55–62. (PMID: 10.1111/ger.1237630350429)
Ono S, Ishimaru M, Yamana H, Morita K, Ono Y, Matsui H, et al. Enhanced oral care and health outcomes among nursing facility residents: analysis using the National Long-Term Care suppase in Japan. J Am Med Dir Assoc. 2017;18:277e1–5. (PMID: 10.1016/j.jamda.2016.11.024)
Tsutsui T, Muramatsu N. Care-needs certification in the long-term care insurance system of Japan. J Am Geriatr Soc. 2005;53:522–7. (PMID: 10.1111/j.1532-5415.2005.53175.x15743300)
Langan SM, Benchimol EI, Guttmann A, Moher D, Petersen I, Smeeth L, et al. Setting the RECORD straight: developing a guideline for the REporting of studies conducted using Observational routinely collected data. Clin Epidemiol. 2013;5:29–31. (PMID: 234133213570075)
Ito K, Edahiro A, Watanabe Y, Ohara Y, Motohashi Y, Morishita S, et al. Qualitative analysis of the vocabulary used in work logs of a preventive programme for elderly oral function and nutrition. J Oral Rehabil. 2019;46:723–9. (PMID: 10.1111/joor.12804310045236850297)
Serra-Prat M, Palomera M, Gomez C, Sar-Shalom D, Saiz A, Montoya JG, et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing. 2012;41:376–81. (PMID: 10.1093/ageing/afs00622311895)
The Japanese Society of Dysphagia Rehabilitation. Number of Certified Professionals by Occupation - Composition by Prefecture. (In Japanese). (2022). https://www.jsdr.or.jp/wp-content/uploads/file/doc/licensed-list.pdf . Accessed 02 October 2022.
Japanese Nursing Association. List of registered certified nurses by field. (In Japanese). (2021). https://nintei.nurse.or.jp/nursing/wp-content/uploads/2021/05/cn_1bunnyabetsu_syozokusakisyubetsu.xlsx . Accessed 02 October 2022.
The Japanese Society of Gerondontology. Survey on the implementation of oral health management in long-term care insurance facilities and the role of cooperating dental care institution. (2019). (In Japanese) chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.tmghig.jp/research/info/cms_upload/ba3e1deb8f4eb56e65c9833cc2b3b8d9_1.pdf Accessed 02 October 2022.
Tokyo Metropolitan Institute of Gerontology. Survey on the Improvement of Oral Health and Nutritional Management for Users of Day Care Services. (2019). (In Japanese) chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.gerodontology.jp/about/file/plan/2018_enhancement_business_report.pdf Accessed 02 October 2022.
Engh MCN, Speyer R. Management of Dysphagia in nursing Homes: a National Survey. Dysphagia. 2021;37:266–76. (PMID: 10.1007/s00455-021-10275-7336600708948132)
Raheem D, Carrascosa C, Ramos F, Saraiva A, Raposo A. Texture-modified food for dysphagic patients: a Comprehensive Review. Int J Environ Res Public Health. 2021;18:5125. (PMID: 10.3390/ijerph18105125340660248150365)
Levenson SA, Walker VL. It is time to revamp approaches to managing Dysphagia in nursing Homes. J Am Med Dir Assoc. 2019;20:952–5. (PMID: 10.1016/j.jamda.2019.06.00531353044)
Plastow NA, Atwal A, Gilhooly M. Food activities and identity maintenance in old age: a systematic review and meta-synthesis. Aging Ment Health. 2015;19:667–78. (PMID: 10.1080/13607863.2014.97170725373998)
Aktas-Polat S, Polat S. A theoretical analysis of food meaning in anthropology and sociology. 2020;68:278 – 93.
Hilario AP, Augusto FR. Feeding the family at the end-of-life: an ethnographic study on the role of food and eating practices for families facing death in Portugal. Health Soc Care Community. 2021;29:e232–9. (PMID: 10.1111/hsc.1334533704855)
National Health Service. Guidance-Commissioning Excellent Nutrition and Hydration.2015. https://www.england.nhs.uk/wp-content/uploads/2015/10/nut-hyd-guid.pdf . Accessed 08 August 2023.
National Health Service. “10 key characteristics of ‘good nutrition and hydration care’.“ https://www.england.nhs.uk/commissioning/nut-hyd/10-key-characteristics/. Accessed 08 August 2023.

17K0922 JSPS KAKENHI as a Grant-in-Aid for Scientific Research (C); 17K0922 JSPS KAKENHI as a Grant-in-Aid for Scientific Research (C); 17K0922 JSPS KAKENHI as a Grant-in-Aid for Scientific Research (C)

Keywords: Dysphagia; Long-term care facility; National claim database; Older adults; Policy evaluation; Secondary analysis

Date Created: 20231002 Date Completed: 20231004 Latest Revision: 20231121

20250114

PMC10546654

10.1186/s12913-023-09990-8

37784114