Distinct effects of community-based activities on long-term care needs: A study using zero-inflated Poisson regression
Social isolation among older adults is a major concern in countries where the need for long-term care (LTC) has increased. However, no previous observational study has identified which community-based activities can reduce the LTC needs of older adults. Our study fills the gap between interventional and observational studies. Data were drawn from a survey of LTC insurance needs in A city in Fukuoka Prefecture, Japan. A city is one of the municipalities participating in the longevity improvement and fair evidence (LIFE) study that provides data from government-administered LTC insurance enrollees and public assistance recipients. To measure the precise impact of self-assessed poor health (SAPH) on the needs of LTC by living arrangements, we adopted the two-stage residual inclusion approach and estimated zero-inflated Poisson (ZIP) models. We uncovered two major findings. First, the results of ZIP models showed that the magnitude of the impact of SAPH on the LTC needs of older adults living alone was five times that of older adults living with other family members. Second, participation in community-based care prevention can reduce LTC needs among older adults living alone. The same effect was not observed in older adults cohabiting with family members. Although older adults tend to refrain from going out when their subjective health is poor, the top strategy for reduction of LTC needs is the promotion of participation in community-based care prevention for older adults living alone.
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